Biomedical waste segregation compliance scoring system: to analyze, strengthen, monitor, and step up waste management in healthcare facilities.

Introduction: segregation of biomedical waste (BMW) is the foremost and prime step for effective BMW management. This study was taken up to assess the BMW segregation compliance in patient care areas using a checklist-based scoring system to analyze the segregation compliance and establish feedback-based training programs. Methods: this study was conducted between January 2020 to December 2021 at a government tertiary care hospital in Hyderabad. The compliance was calculated by giving a score of one for each day, such that if there was no noncompliance (NC) the score was 100% for a given location at the end of the month. A score of minus one was given for each day a noncompliance was noted and transfigured into percentages. A score of 100% was considered good, and below 95% was considered an action point necessitating root cause analysis and training. Results: the BMW segregation compliance scores of the hospital for the year 2020 (96.5%) were compared with 2021 scores (97.5%). The outpatient department (OPD) and ICU had the poorest compliance rate of 93.7% and 93.6% respectively, compared to wards (96.2%). The most common factors influencing NC in BMW segregation were the joining of new staff, relocation, or new establishment of wards. The most common segregation error was found in the yellow disposal bags pertaining to the disposal of personal protective equipment. Conclusion: this easy and simple scoring system was established to improve the segregation compliance of BMW. End of each month an area wise compliance is easily made such that areas with low scores could be trained.

Common Instances of Low-value Care in Inflammatory Bowel Diseases.

Value-based care focuses on improving the quality, effectiveness, and efficiency of health care while controlling costs. Low-value care implies services or interventions that provide little or no benefit to patients, have the potential to cause harm, incur unnecessary cost to patients, or waste limited health care resources. In this review, we discuss common instances of low-value care along the spectrum of management in inflammatory bowel diseases (IBD). These include low value care in: (1) diagnosis and monitoring of IBD: utilization of serological markers to screen and diagnose IBD, over-reliance on symptoms for monitoring disease, failure to employ treat-to-target strategies in symptomatic patients with IBD, and annual surveillance colonoscopies in patients at low risk of developing dysplasia; (2) treatment of IBD: use of 5-aminosalicylates in Crohn's disease, continuation of 5-aminosalicylates after escalation to immunosuppressive therapy, chronic corticosteroid use without steroid-sparing strategies, step therapy for Crohn's disease, failure to optimize tumor necrosis factor antagonists in patients with active disease and subsequently de-intensification of therapies in those who have achieved stable remission; and (3) management of hospitalized patients with IBD: routine cross-sectional imaging for patients with IBD presenting to the emergency department, withholding pharmacological prophylaxis for venous thromboembolism in patients hospitalized with IBD flare, and prolonged use of high-dose intravenous corticosteroids in patients with acute severe ulcerative colitis. This review is meant to bring attention to value-based care in IBD and provide guidance to treating practitioners. Future studies on systematic evaluation of high- and low-value care in patients with IBD are warranted.

Quantitative analysis of healthcare waste generation and composition in Antalya, Turkey.

Health-care waste (HCW) may pose a risk to human health and the environment because of its infectious and/or toxic properties. This study was conducted to evaluate the quantity and composition of all the HCW generated by different producers in Antalya, Turkey, using data obtained from two online systems. Accordingly, this study explored the trends in healthcare waste generation (HCWG) between 2010 and 2020 and the impact of COVID-19 on HCWG by comparing the post- and pre-COVID-19 patterns based on the data obtained from 2,029 different producers. The collected data were based on the waste codes reported by the European Commission, were characterised based on the definition of the World Health Organization, and were further analysed according to the healthcare types defined by the Turkish Ministry of Health to characterize HCW. The findings indicate that the main HCW contributor was infectious waste (94.62 %), most of which was generated by hospitals (80 %). This is due to the inclusion of only HCW fractions in this study and to the definition of infectious waste considered. This study indicates that the categorisation into the type of HCSs may be a good option to assess the increase of HCW quantities, in accordance with the service type, size, and the effects of COVID-19. The correlation results for hospitals offering primary HCS revealed a strong relationship between the HCWG rate and the population per year. This approach may help estimate future trends to promote better HCW management practices for the specific cases considered, and it can even be applied to other cities.

Status of health care waste management plans and practices in public health care facilities in Gauteng Province, South Africa.

BACKGROUND: Health care waste management is a challenge due to the composition of the waste generated within a health care facility, of which 85% is domestic waste, and at least 15% is hazardous waste or health care risk waste (has been in contact with blood, body fluids or tissues from humans and could cause disease). In this study, we evaluated the status quo of health care waste management plans (HCWMPs) and practices in public health care facilities in Gauteng Province, South Africa. METHODS: A situational analysis was employed in health care facilities (HCFs) that generated more than 20 kg (N = 42) of health care risk waste (HCRW) per day. Data was collected from officials responsible for the management of health care waste using a self-administered questionnaire whilst Chief Executive Officers/ managers of the HFCs were interviewed. RESULTS: The results showed that most (79.0%) of the health care waste officers (HCWOs) as well as management (84.6%) agreed to have HCWMPs in place. The majority (76.9%) of the HCFs have a dedicated person appointed to manage health care waste with the majority (67%) being environmental health practitioners. According to management, only 30.8% have formally appointed an integrated HCW committee. Only 11.7% of the HCWOs are guided by the Occupational Health and Safety Act to develop their HCWMPs with only 20.5% with health care waste minimisation strategies in place. CONCLUSION: The study concluded that there is limited integration of HCWMPs as inadequate health and safety aspects, environmental pollution as well as community participation was reported. The novelty of the study is to contribute to a body of knowledge, information on the establishment of an effective health care waste management system in public health care facilities and for decision-making purposes.

Presented and prioritizing waste management strategies using SWOT and QSPM approach in two private hospitals in Yazd in 2021.

BACKGROUND: This study aimed to present a strategic waste management in two private hospitals in Yazd using models of the strengths, weaknesses, opportunities, and threats (SWOT) and quantitative strategic planning matrix (QSPM). METHODS: The strengths, weaknesses, opportunities, and threats of the organization was identified according to existing documents and expert team. The internal and external factors were identified by internal factor evaluation (IFE) and external factor evaluation (EFE) matrices. The strategies to improve waste management in two hospitals were presented by comparing internal and external factors. Finally, the attractiveness table was compiled and weighted using the QSPM method to prioritize the strategies. RESULTS: The results demonstrated that 24 strengths, 30 weaknesses, 16 opportunities, and 22 threats were identified. The final score of internal and external factors for hospital A and B were (X: 2.37, Y:1.88) and (X: 2.37, Y: 2.01), respectively. Based on the results, 12 strategies were presented. Finally, the strategy of "the improvement of green management indicators" was implemented as a priority according to QSPM matrix. CONCLUSION: The result of this study duplicated that using the QSPM and SWOT models is assist to present viable strategies to improve the health-care waste management.

Pythagorean fuzzy entropy measure-based complex proportional assessment technique for solving multi-criteria healthcare waste treatment problem.

With the increasing risk to human health and environmental issues, the selection of appropriate management and treatment of healthcare waste has become a major problem, especially in developing countries. There are various alternatives to dispose of health care waste. The important is to assess the best alternative among them. The assessment of each alternative should be done based on public health, psychological, economic, environmental, technological, and operational aspect. The selection of the best health care waste treatment (HCWT) alternative is a complicated, multi-criteria decision-making (MCDM) problem involving numerous disparate qualitative and quantitative features. Hence, in this research article, the MCDM method is presented for estimating and choosing the best alternative of HCWT by COPRAS technique in a Pythagorean fuzzy set (PFS). Here, in this paper, first of all, a new entropy measure on PFSs is proposed and its validity is studied. Thereafter, the MCDM technique Complex Proportional Assessment (COPRAS) is discussed in which the criteria weights are assessed by the proposed entropy measure and score function to enhance an efficacy and efficiency of the proposed technique. Furthermore, the above-defined technique is employed to resolve the real-life problem to obtain the best treatment alternative to disposal of the health care waste. Finally, sensitivity analysis is presented to rationale the proposed viewpoint for prioritizing HCWT alternatives.

Variability in the Use of Disposable Surgical Supplies: A Surgeon Survey and Life Cycle Analysis.

PURPOSE: A substantial amount of waste is generated during surgery, yet few studies have investigated this problem. Therefore, we conducted a multicenter survey to investigate how the variation in the use of disposable supplies contributes to the environmental and financial burdens of health care. METHODS: We created a questionnaire to identify differences in supply use and practice characteristics among hand surgeons who participated in the Wrist and Radius Injury Surgical Trial. We determined the average cumulative cost of 10 key surgical items based on the responses. Subsequently, we estimated the kilograms of carbon dioxide emitted during the life cycle of supplies, from raw material extraction to production and disposal, using economic input-output life cycle analysis. RESULTS: Thirty-five surgeons from 19 institutions responded to the survey (65% response rate). Based on the difference in costs between surgeons who used the fewest and the most supplies, we determined that expenditures and carbon dioxide emissions could decrease by $22.47 and 10.9 kg per procedure, respectively, with leaner use of 10 key items. Furthermore, assuming that surgeon variation in supply use is present in other surgical subspecialties, we estimated that $2.4 billion in savings and an 800.6 thousand metric ton reduction in carbon emissions could be achieved if all US surgeons reduced their supply use by this amount. CONCLUSIONS: This study revealed considerable variations in the use of disposable supplies among hand surgeons, highlighting the need for evidence-based tools, policies, and education campaigns to reduce hospital waste across health care systems. CLINICAL RELEVANCE: Optimal use of disposable supplies is necessary to reduce the cost and environmental burden of hand surgery care.

Using the Water and Sanitation for Health Facility Improvement Tool (WASH FIT) in Zimbabwe: A Cross-Sectional Study of Water, Sanitation and Hygiene Services in 50 COVID-19 Isolation Facilities.

The availability of water, sanitation and hygiene (WASH) services is a key prerequisite for quality care and infection prevention and control in health care facilities (HCFs). In 2020, the COVID-19 pandemic highlighted the importance and urgency of enhancing WASH coverage to reduce the risk of COVID-19 transmission and other healthcare-associated infections. As a part of COVID-19 preparedness and response interventions, the Government of Zimbabwe, the United Nations Children's Fund (UNICEF), and civil society organizations conducted WASH assessments in 50 HCFs designated as COVID-19 isolation facilities. Assessments were based on the Water and Sanitation for Health Facility Improvement Tool (WASH FIT), a multi-step framework to inform the continuous monitoring and improvement of WASH services. The WASH FIT assessments revealed that one in four HCFs did not have adequate services across the domains of water, sanitation, health care waste, hand hygiene, facility environment, cleanliness and disinfection, and management. The sanitation domain had the largest proportion of health care facilities with poor service coverage (42%). Some of the recommendations from this assessment include the provision of sufficient water for all users, Menstrual Hygiene Management (MHM)- and disability-friendly sanitation facilities, handwashing facilities, waste collection services, energy for incineration or waste treatment facilities, cleaning supplies, and financial resources for HCFs. WASH FIT may be a useful tool to inform WASH interventions during the COVID-19 pandemic and beyond.

Emergency response to the explosive growth of health care wastes during COVID-19 pandemic in Wuhan, China.

During the Coronavirus Disease 2019 (COVID-19) as a worldwide pandemic, the security management of health care wastes (HCWs) has attracted increasing concern due to their high risk. In this paper, the integrated management of HCWs in Wuhan, the first COVID-19-outbreaking city with over ten millions of people completely locking down, was collected, investigated and analyzed. During the pandemic, municipal solid wastes (MSWs) from designated hospitals, Fangcang shelter hospitals, isolation locations and residential areas (e.g. face masks) were collected and categorized as HCWs due to the high infectiousness and strong survivability of COVID-19, and accordingly the average production of HCWs per 1000 persons in Wuhan explosively increased from 3.64 kg/d to 27.32 kg/d. Segregation, collection, storage, transportation and disposal of HCWs in Wuhan were discussed and outlined. Stationary facilities, mobile facilities, co-processing facilities (Incineration plants for MSWs) and nonlocal disposal were consecutively utilized to improve the disposal capacity, from 50 tons/d to 280.1 tons/d. Results indicated that stationary and co-processing facilities were preferential for HCWs disposal, while mobile facilities and nonlocal disposal acted as supplementary approaches. Overall, the improved system of HCWs management could meet the challenge of the explosive growth of HCWs production during COVID-19 pandemic in Wuhan. Furthermore, these practices could provide a reference for other densely populated metropolises.

Selection of the best healthcare waste disposal techniques during and post COVID-19 pandemic era.

In recent years, municipal authorities especially in the developing nations are battling to select the best health care waste (HCW) disposal technique for the effective treatment of the medical wastes during and post COVID-19 era. As evaluation of various disposal alternatives of HCW and selection of the best technique requires considering various tangible and intangible criteria, this can be framed as multi-criteria decision-making (MCDM) problem. In this paper, we propose an assessment framework for the selection of the best HCW disposal technique based on socio-technical and triple bottom line perspectives. We have identified 10 criteria on which the best HCW disposal techniques to be selected based on extant literature review. Next, we use Fuzzy VIKOR method to evaluate 9 HCW disposal alternatives. The effectiveness of the proposed framework has been demonstrated with a real-life case study in Indian context. To check the robustness of the proposed methodology, we have compared the results obtained with Fuzzy TOPSIS (Technique of Order Preference Similarity to the Ideal Solution). The results help the municipal authorities to establish a methodical approach to choose the best HCW disposal techniques. Our findings indicate that incineration is the best waste disposal technique among the available alternatives. Even if the dataset indicates 'incineration' is the best method, we must not forget about the environmental concerns arising from this method. In COVID time, incineration may be the best method as indicated by the data analysis, but "COVID" should not be an excuse for causing "Environmental Pollution".

We Know Health Is Not Elective: Impacts of COVID-19.

Several months into the impact of the global COVID-19 pandemic, the authors use the framework of "radical uncertainty" and specific regional health care data to understand current and future health and economic impacts. Four key areas of discussion included are: (1) How did structural health care inequality manifest itself during the closure of all elective surgeries and visits?; (2) How can we really calculate the so-called untold burden that resulted from the closure, with a special emphasis on primary care?; (3) The Pennsylvania experience - using observations from the population of one major delivery ecosystem (Jefferson Health), a major accountable care organization (Delaware Valley ACO), and statewide data from Pennsylvania; and (4) What should be the priorities and focus of the delivery system of the future given the dramatic financial and clinical disruption of COVID-19?

An approach to assess and identify polymers in the health-care waste of a Brazilian university hospital.

This work presents the health-care waste (HCW) management and an approach to assess and identify polymers in a General Surgery Unit - Internment Service (GSU) of a Brazilian university hospital, to estimate the main polymers presenting in medical devices that are consumed during a year, discarded either as infecting (Group A) or as scarifying residue (Group E). Among the waste produced from the medical devices, 3.14 ton (98.79%) were composed of polymers (63.06% of plastics and 35.73% elastomers) while around 0.03 ton (1.21%) by metals. The proposed approach is composed of 4 steps: (1) Collecting data about consumed medical devices to be categorized into the residues Groups (A and E); (2) Identifying the polymeric composition with information provided by suppliers; (3) Characterizing the polymer functional groups by Fourier-Transform Infrared Spectroscopy (FTIR) and (4) Determining the polymer melting point by Differential Scanning Calorimetry (DSC). According to the results, the analyzed HCW was composed mainly of polypropylene (80.88%), high-density polyethylene (5.28%), polystyrene (4.51%), and cellulose (3.58%), from a total of 11 different polymers.

Impact of an education and multilevel social comparison-based intervention bundle on use of routine blood tests in hospitalised patients at an academic tertiary care hospital: a controlled pre-intervention post-intervention study.

BACKGROUND: Repetitive inpatient laboratory testing contributes to waste in healthcare. We evaluated an intervention bundle combining education and multilevel social comparison feedback to safely reduce repetitive use of inpatient routine laboratory tests. METHODS: This non-randomised controlled pre-intervention post-intervention study was conducted in four adult hospitals from October 2016 to March 2018. In the medical teaching unit (MTU) of the intervention site, learners received education and aggregate social comparison feedback and attending internists received individual comparison feedback on routine laboratory test utilisation. MTUs of the remaining three sites served as control units. Number and cost of routine laboratory tests ordered per patient-day before and after the intervention was compared with the control units, adjusting for patient factors. Safety endpoints included number of critically abnormal laboratory test results, number of stat laboratory test orders, patient length of stay, transfer rate to the ICU, and 30-day readmission and mortality. RESULTS: A total of 14 000 patients were included. Pre-intervention and post-intervention groups were similar in age, sex, Charlson Comorbidity Index and length of stay. From the pre-intervention period to the post-intervention period, significantly fewer routine laboratory tests were ordered at the intervention MTU (incidence rate ratio=0.89; 95% CI 0.79 to 1.00; p=0.048) with associated costs savings of $C68 877 (p=0.020) as compared with the control sites. The variability in the ordering pattern of internists at the intervention site also decreased post-intervention. No worsening was noted in the safety endpoints between the pre-intervention and post-intervention period at the intervention unit compared with the controls. CONCLUSIONS: Combination of education and multilevel social comparison feedback significantly and safely led to cost savings through reduced use of routine laboratory tests in hospitalised patients.

Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and Meta-Analysis.

BACKGROUND: Given the importance of proper management of Health Care Waste Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM. METHODS: The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. RESULTS: Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54-3.54) which was significant statistically (P<0.05). Also, interventions were considerably effective in improving the indicators of waste production amount, waste management costs and overall waste management performance. CONCLUSION: Despite positive effect of interventions, due to the methodological deficiencies of published studies and high heterogeneity in results of studies, caution should be exercised in interpreting and using the results of the studies.

Knowledge and Practices of Health-Care Waste Management among Health Workers in Lassa Fever Treatment Facility in Southeast Nigeria.

BACKGROUND: The threat of endemic, emerging, and reemerging infectious diseases, especially the viral hemorrhagic fevers demands effective health-care waste management (HCWM) among health-care workers. The study was intended to assess the knowledge and practices of HCWM among the cleaning staff in a Lassa fever (LF) treatment facility. MATERIALS AND METHODS: This was a cross-sectional descriptive study of 234 cleaning staff of Federal Teaching Hospital Abakaliki recruited by systematic random sampling. Data collection was with semi-structured questionnaires. Knowledge and practices of respondents were assessed using cutoff score of 75%; score of 75% and above being interpreted as good and <75% as poor. Data were analyzed using Epi™ Info Version 7.2. RESULTS: There were 177 (75.6%) female and 57 (24.4%) male cleaning staff with a mean age of 33.4 years (±8.3). Among all the respondents, 18 (7.7%) had no formal education, while others had varying levels of education (primary, 43 [18.4%]; secondary, 133 [56.8%]; tertiary, 40 [17.1%]). Only 134 (57.3%) of the respondents had ever been trained on HCWM, of which 77 (57.5%) of them were trained in 2018. The proportion of respondents with good knowledge of HCWM was 41.5%. In addition, only 83 (35.5%) properly categorized the body parts, body fluids, and fetuses as pathological waste. About one-third, 77 (33.3%), had knowledge of steps in HCWM and 45.3% knew of diseases transmitted through health-care waste with 171 (62.8%) identifying LF as one of the diseases. The proportion of respondents with good practices of HCWM was 53.9% with only 131 (56.0%) segregating waste in specified color-coded containers. Among the factors examined, none was significantly associated with knowledge and practice of participants on HCWM. CONCLUSION: The proportions of the cleaning staff with good knowledge and practices of HCWM were low. There is a need to train and retrain hospital staff on proper HCWM as well as need for proper supervision and monitoring.

Health-Care Waste Management in Public Sector of Tripura, North-East India: An Observational Study.

BACKGROUND: Hospitals generate variety of waste which is hazardous to patients, health workers, community, and environment. Proper health-care waste management (HCWM) requires infrastructure, trained workforce, law and supervision. More than 80% of the population of Tripura depends on the public health-care system but the knowledge and practice of health-care workers regarding HCWM in the public sector of Tripura is not clear. OBJECTIVES: The objective was to assess the knowledge and practice of health-care workers regarding HCWM and to take an account of the existing HCWM facilities in the public sector of Tripura. STUDY DESIGN: This was a facility-based, cross-sectional study. MATERIALS AND METHODS: This study was conducted during 1st November 2015 to 16th October 2017 among 544 health-care workers working in thirty health institutions chosen by stratified random sampling. Data entry and analysis was performed using SPSS software version 15.0. RESULTS: Overall, 37.68% of the respondents had fair knowledge regarding HCWM, 8.27% received in-service training on HCWM, 66.17% were immunized against hepatitis B and > 90% of the respondents knew about segregation of waste at source but knowledge regarding the use of colored bins for this purpose varied widely across different categories of participants. Housekeeping staff were ignorant about most of these issues. The importance of disinfecting the waste before disposal was known to 83.63% of the workers. Proper HCWM was practiced by 39.15% and segregation of waste at source into colored bins was followed by 23.3% of the respondents. The study revealed both waste management facilities and display of waste management policy as poor. Technical qualification and in-service training were identified as the statistically significant determinants of knowledge and practice of HCWM (P < 0.05). CONCLUSION: HCWM scenario including knowledge of health-care workers in Tripura is lacking. Installing proper waste management facilities, raising technical qualification at recruitment and in-service training may improve the situation.

Polycyclic aromatic hydrocarbons (PAHs) formation during the fast pyrolysis of hazardous health-care waste.

Health-care waste management is a challenge for the health sector. Currently, pyrolysis technologies are being used to treat medical waste that can convert it to a hydrocarbon fuel. In the present study, hazardous health-care waste was pyrolyzed using a continuous tubular fast pyrolysis reactor. Mass balance analysis and formation of the 16 polycyclic aromatic hydrocarbons (PAHs), characterized by USEPA as priority pollutants, and was studied during the pyrolysis process in a wide range of operation conditions, i.e., reaction temperature (300-700 °C), residence time (100-190 s) and waste particle size (1-3 cm). Response surface methodology (RSM) and central composite design (CCD) were applied to optimize the operating variables. Cracking and decomposition of feedstock occurred almost optimally in 700 °C resulting in the generation of 73.4% liquid and 24.1% char. The PAHs were characterized in significant concentrations in pyrolytic oil (121-29440 mg/lit) and char (223-1610 mg/kg) products. The formation of total USEPA listed PAH components varied by the operating ranges of temperature, residence time and waste size. In the pyrolytic oil phase, the formation of total PAHs was drastically increased by increasing the waste particle size. It is also found that increasing the temperature and having longer residence times have a high influence on the total 16 USEPA PAHs formation rate in the char phase. It is concluded that fast pyrolysis of hazardous health-care waste, as thermal treatment method, would influence the formation and destruction of PAHs and their fraction to a different extent depending on the role of operating variables.

Biomedical waste management in Ayurveda hospitals - current practices and future prospectives.

Biomedical waste management is an integral part of traditional and contemporary system of health care. The paper focuses on the identification and classification of biomedical wastes in Ayurvedic hospitals, current practices of its management in Ayurveda hospitals and its future prospective. Databases like PubMed (1975-2017 Feb), Scopus (1960-2017), AYUSH Portal, DOAJ, DHARA and Google scholar were searched. We used the medical subject headings 'biomedical waste' and 'health care waste' for identification and classification. The terms 'biomedical waste management', 'health care waste management' alone and combined with 'Ayurveda' or 'Ayurvedic' for current practices and recent advances in the treatment of these wastes were used. We made a humble attempt to categorize the biomedical wastes from Ayurvedic hospitals as the available data about its grouping is very scarce. Proper biomedical waste management is the mainstay of hospital cleanliness, hospital hygiene and maintenance activities. Current disposal techniques adopted for Ayurveda biomedical wastes are - sewage/drains, incineration and land fill. But these methods are having some merits as well as demerits. Our review has identified a number of interesting areas for future research such as the logical application of bioremediation techniques in biomedical waste management and the usage of effective micro-organisms and solar energy in waste disposal.

Role of National Policy in Improving Health Care Waste Management in Nigeria.

BACKGROUND: As Nigeria strives to improve health services nationwide, there is a corresponding increase in laboratory testing, care and treatment activities, producing more healthcare waste that must be safely managed. In the past, Nigeria lacked an enabling environment for healthcare waste management, as it did not have a national health care waste management policy. However, in 2013 a policy and strategic plan for healthcare waste management was developed to address this problem. OBJECTIVES: The present study performed an environmental safeguard audit to determine the level of implementation of the 2013 national policy in the 36 states and Federal Capital Territory in Nigeria. We also sought to determine whether the 2013 national policy has had an impact on healthcare waste management. METHODS: The present study was conducted in 1921 health facilities, selected using the probability proportional to size sampling method. RESULTS: The present study found that 44.8% of health facilities surveyed had healthcare waste management work plans adapted from the 2013 national policy. In addition, 89.2% of health facilities segregated waste. This is an important improvement, as previous studies reported that there was little to no waste segregation at health facilities. Furthermore, 41.4% of health facilities had designated persons or units handling healthcare waste, in contrast to previous studies which found no designated person or unit responsible for healthcare waste. However, the quality of healthcare waste management varied across states and health facilities. DISCUSSION: Following the introduction of healthcare waste management policy, health facilities in Nigeria have improved waste management practices. However, training, availability of required tools and functional governance structures are essential to the implementation of an effective healthcare waste management policy. CONCLUSIONS: The study findings show that safe healthcare waste management can be implemented if the government leads by providing policy and required resources, while health facilities put standard operating procedures in place to guide day to day healthcare waste management operations. PARTICIPANT CONSENT: Obtained. ETHICAL APPROVAL: The protocol was approved by the National Health Research Ethics Committee of Nigeria. COMPETING INTERESTS: The authors declare no competing financial interests.

Generation and composition of waste from medical histopathology laboratories.

The aim of this work was to record the quantities and composition of medical waste (MW) generated by public and private medical histopathology laboratories (HISTOLB) and to provide pertinent waste generation design coefficients (e.g. g/examinee) for those laboratories. This can be a useful coefficient when designing medical waste treatment facilities. The study was conducted on three public and four private HISTOLBs in the city of Thessaloniki (Greece) for a period of 5 months. One sampling week was selected randomly per month. During the study period, the examinees per week were 108 and 90 in the public and private HISTOLBs, respectively. According to the results, 57% of the total MW generated in both the public and private laboratories were toxic waste (TXW), namely the liquid formaldehyde that is used to preserve the tissue. The mixed hazardous waste (MHW) comprised 28% and 24%, respectively, of the total MW, in the public and private facilities, respectively. The infectious waste constituted around 15% of the total MW generated in both types of facilities. Urban type waste was always less than 4% by weight. The total mean MW generated in the public and private laboratories were 208 ±â€¯543 (n = 1614) and 195 ±â€¯512 (n = 1789) g/examinee, respectively. A large variance among the mean MW generation rates of the participating individual laboratories that belonged to the same category was observed. The dominant fraction of the infectious waste was the plastic containers that contained the tissue samples, being around 75% of the total infectious waste, followed by the latex gloves (being around 17% of the infectious waste).