Variability of the treated biomedical waste disposal behaviours during the COVID lockdowns.

Literature review suggests that studies on biomedical waste generation and disposal behaviors in North America are limited. Given the infectious nature of the materials, effective biomedical waste management is vital to the public health and safety of the residents. This study explicitly examines seasonal variations of treated biomedical waste (TBMW) disposal rates in the City of Regina, Canada, from 2013 to 2022. Immediately before the onset of COVID-19, the City exhibited a steady pattern of TBMW disposal rate at about 6.6 kg∙capita-1∙year-1. However, the COVID-19 pandemic and its associated lockdowns brought about an abrupt and persistent decline in TBMW disposal rates. Inconsistent fluctuations in both magnitude and variability of the monthly TBMW load weights were also observed. The TBMW load weight became particularly variable in 2020, with an interquartile range 4 times higher than 2019. The average TBMW load weight was also the lowest (5.1 tonnes∙month-1∙truckload-1) in 2020, possibly due to an overall decline in non-COVID-19 medical emergencies, cancellation of elective surgeries, and availability of telehealth options to residents. In general, the TBMW disposal rates peaked during the summer and fall seasons. The day-to-day TBMW disposal contribution patterns between the pre-pandemic and post-pandemic are similar, with 97.5% of total TBMW being disposed of on fixed days. Results from this Canadian case study indicate that there were observable temporal changes in TBMW disposal behaviors during and after the COVID-19 lockdowns.

Healthcare waste generation and quantification in public health centres in Addis Ababa, Ethiopia.

BACKGROUND: Healthcare waste produced in healthcare activities entails higher risk of infection and injuries than municipal waste. In developing countries healthcare waste has not received much attention and has been disposed of together with municipal wastes. Modern method of disposal of healthcare waste have been introduced to most healthcare institutions mismanagement and increased in production in public health centres in Ethiopia is important issues. The aim of the study was to assess the type of healthcare waste generation and quantification in selected public health centres in Addis Ababa, Ethiopia. METHODS: An institution based cross-sectional study were conducted from January to February 2018. Fifteen health centres in Addis Ababa City Administration were selected for this study. Data were collected by using by different color plastic bags (Black plastic bags for non-hazardous wastes, Yellow plastic bags for hazardous wastes and Yellow safety box for needles and Red bags for pharmaceutical wastes and toxic wastes). The collected wastes were measured by weighing scale and were written to data entry sheet. To assure the data quality calibration of weighing scale was made by the standard weight every morning. EPI INFO TM7 and IBM SPSS were used for data entry, cleaning and analysis. RESULTS: The mean healthcare waste generation was 10.64+5.79Kg/day of which 37.26% (3.96+2.20Kg/day) was general waste and 62.74% (6.68+4.29) was hazardous waste from the studies health centres. Total hazardous waste; sharps, infectious, pathological and pharmaceutical wastes constitutes mean (±SD) 0.97 ±1.03, 3.23 ± 2.60, 2.17±1.92 and 0.25 ±0.34 kg/day respectively. Healthcare waste 29.93% and 0.32% were generated from delivery and post-natal case team and nutrition and growth monitoring case team respectively. The annual mean+ SD of healthcare waste generation rate per health centres were 3807.53+ 2109.84 Kg/year. CONCLUSION: The finding in this study showed there was an increased in hazardous healthcare waste in amount as compared to the WHO standard 85% non-hazardous waste and 10% hazardous waste and 5% toxic wastes. The healthcare waste management practices about segregation, collection, transportation and disposal at the source is crucial to decrease in quantity. Generally unselective handling and disposal of healthcare wastes is a concern.

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

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

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

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

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 the Environmental and Economic Costs of Single-Department Infectious Waste Disposal.

PURPOSE: The aim of this study was to demonstrate the efficacy of zero-cost interventions on the reduction of infectious waste (IW) stream production in interventional radiology (IR). METHODS: This quality improvement initiative was developed using needs identification through department-wide meetings with IR stakeholders (physicians, nurses, and radiologic technologists). Department leadership identified and implemented two interventions to reduce disposal of noninfectious waste (NIW) in the IW stream. First, hospital waste management provided focused education for sorting IW versus NIW to IR staff members. Next, the number of IW bins was reduced, and the IW bins were strategically placed on the perimeter of the room. Radiologic technologists tracked IW and NIW bags per case for 25 case days before the intervention and 175 case days after the intervention. A run chart was created to visualize change over time. Wilcoxon rank sum and signed rank tests were performed to evaluate the difference in IW and NIW bags per case before and after the intervention. A goal of significant reduction in NIW stream production was set. RESULTS: Before the intervention, the production of IW and NIW bags per case was similar (median, 1.0 [interquartile range (IQR), 0.86-1.31] vs 1.1 [IQR, 0.86-1.40]; P = .20). After the intervention, IW bags per case decreased (median, 1.0 [IQR, 0.86-1.31] vs 0.05 [IQR, 0.00-0.13]; P < .001). Fewer IW bags than NIW bags were produced per case after the intervention (median, 0.05 [IQR, 0.00-0.13] vs 1.53 [IQR, 1.30-1.76]; P < .001). CONCLUSIONS: Zero-cost interventions, including focused education, stakeholder engagement, and strategic placement of waste bins, can significantly reduce the environmental and economic impact of waste produced in IR.

Factors Associated with Improving Appropriate Medical Sharps Disposal Practice Among Diabetic Patients Using Insulin Therapy.

Background: Diabetic patients are always in contact with medical sharps, such as pen needles, lancets, and syringes. Sometimes, patients improperly dispose of these items and cause needle stick injuries. This study aimed to identify factors that improve appropriate manner in which individuals with diabetes who require insulin therapy dispose of medical sharps. Methods: In December 2019, a cross-sectional investigation was undertaken amongst insulin therapy-dependent diabetic patients visiting Jakarta's Fatmawati General Hospital. A questionnaire was formulated to appraise medical sharps' disposal procedure. The data gathered the questionnaire, including age, gender, educational level, employment status, length of time as a diabetic, duration of insulin treatment, and receipt of formal medical training, were also recorded. Results: Of 103 diabetic patients, 77.3% were over 50 years old, 58.3% were female, 68% were a low level of education, 74.8% were not working, 84.5% were diagnosed with diabetes for more than 5 years, 53.4% were using insulin therapy for more than 5 years, and only 65% had got formal training on medical sharp products disposal. Nearby 83.5% still recap the pen needle insulin with the inner needle cap after injecting insulin, and 92.2% still threw medical sharps on the street when traveling outside. Approximately 81.6% of respondents stored their unused needles and lancets in a secured manner that was inaccessible to children. The practice score for proper medical sharps disposal increased from 4.5 to 6.0 as a result of formal training provided by healthcare professionals, as determined by the Mann Whitney Test (p=0.001). Conclusions: Formal training by healthcare workers was the only factor that improved medical sharps disposal practice among diabetic patients using insulin therapy.

Status of waste disposal of sharps outside medical institutions for patients with diabetes: A systematic review.

OBJECTIVES: As the number of people with diabetes increases, so does the amount of household-generated sharp waste, and incorrect sharp disposal methods can expose the public to needle stick injuries This systematic study assesses the relevant factors and current situation of the disposal of sharp waste in diabetes patients. METHODS: In this review, our study comprehensively searched PubMed, MEDLINE, Cochrane Library, EMBASE, Web of Science, and China Biomedical, Wanfang, and CNKI for the concepts of "sharps waste disposal" and "diabetes". RESULT: In 12 identified articles, there are 4155 patients with diabetes. The findings highlight that diabetic patients have a positive attitude towards sharps waste disposal, but lack knowledge and practice of sharps waste disposal, and need to take appropriate measures to improve the rate of proper waste disposal before and during use. Patients with longer duration of diabetes are more likely to engage in inappropriate sharps disposal behaviors. CONCLUSIONS: The findings emphasize that the majority of diabetic patients are unable to handle sharps safely, so more research is needed to find factors associated with sharps waste disposal in diabetic patients and to focus on sharps waste disposal behaviors in patients with longer duration of disease in future clinical practice. TRIAL REGISTRATION: PROSPERO ID. The review was registered on PROSPERO (registration number: CRD42023427592) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42023427592.

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.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices.

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

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.

Responsible waste management: using resources efficiently (Part 2).

This chapter aims to describe the types of waste produced in dental practice, the costs associated with disposal of this waste, and the impact that the disposal method has on the environment and on human health. It discusses the waste hierarchy and explores how dental surgeries can reduce their waste generation through simple changes in practice. The chapter continues by highlighting the benefits of performing a waste audit, with examples of how correct segregation of the waste produced in practice is both cost-effective and reduces the environmental impact of its disposal. Finally, we discuss some of the barriers and enablers of changing waste disposal behaviours in the dental practice and identify how the environmentally minded practitioner can encourage pro-environmental behaviour in their dental team.

Eastern Mediterranean Health Journal [2023; Vol.29, Issue 6]

Eastern Mediterranean Health Journal is the official health journal published by the Eastern Mediterranean Regional Office of the World Health Organization. It is a forum for the presentation and promotion of new policies and initiatives in health services; and for the exchange of ideas concepts epidemiological data research findings and other information with special reference to the Eastern Mediterranean Region. It addresses all members of the health profession medical and other health educational institutes interested NGOs WHO Collaborating Centres and individuals within and outside the Region

المجلة الصحية لشرق المتوسط هى المجلة الرسمية التى تصدرعن المكتب الاقليمى لشرق المتوسط بمنظمة الصحة العالمية. وهى منبر لتقديم السياسات والمبادرات الجديدة فى الصحة العامة والخدمات الصحية والترويج لها، و لتبادل الاراء و المفاهيم والمعطيات الوبائية ونتائج الابحاث وغير ذلك من المعلومات، و خاصة ما يتعلق منها باقليم شرق المتوسط. وهى موجهة الى كل اعضاء المهن الصحية، والكليات الطبية وسائر المعاهد التعليمية، و كذا المنظمات غير الحكومية المعنية، والمراكز المتعاونة مع منظمة الصحة العالمية والافراد المهتمين بالصحة فى الاقليم و خارجه

La Revue de Santé de la Méditerranée Orientale est une revue de santé officielle publiée par le Bureau régional de l’Organisation mondiale de la Santé pour la Méditerranée orientale. Elle offre une tribune pour la présentation et la promotion de nouvelles politiques et initiatives dans le domaine de la santé publique et des services de santé ainsi qu’à l’échange d’idées de concepts de données épidémiologiques de résultats de recherches et d’autres informations se rapportant plus particulièrement à la Région de la Méditerranée orientale. Elle s’adresse à tous les professionnels de la santé aux membres des instituts médicaux et autres instituts de formation médico-sanitaire aux ONG Centres collaborateurs de l’OMS et personnes concernés au sein et hors de la Région

Knowledge, attitudes and practices of sharps waste disposal by diabetic patients in rural South Africa.

BACKGROUND: Sharps waste is hazardous, and it should be disposed of in a proper manner, as it can contribute to transmission of diseases and create a negative impact on the environment. The aim of this investigation was to determine the knowledge, attitudes and practices regarding sharps waste disposal of diabetic patients who inject themselves at home in uMzinyathi District Municipality, a rural area in KwaZulu-Natal, South Africa. METHODS: A quantitative, descriptive cross-sectional study design was adopted using a self-administered questionnaire. Consecutive sampling with a sample size of 308 insulin-dependent diabetic patients from five selected health facilities of uMzinyathi District Municipality was used. RESULTS: The majority of respondents (62.3%) lacked knowledge regarding proper sharps waste disposal. The vast majority of respondents (90.6%) recognised that sharps waste should be separated from general waste. Among those who acknowledged that someone in their home had been injured by a needle, 53.3% stated that they were motivated to change their method of sharps waste disposal. CONCLUSION: The study findings indicated that the majority of the respondents lacked knowledge regarding proper disposal of sharps waste because they were not taught proper methods of sharps waste disposal. There was a general lack of awareness on proper disposal of sharps waste by diabetic patients in the home setting. The study recommended that healthcare workers must place more emphasis on the awareness of proper sharps waste disposal in order to equip diabetic patients with relevant information regarding sharps waste disposal.

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.

Healthcare waste management practice and its predictors among health workers in private health facilities in Ilu Aba Bor Zone, Oromia region, South West Ethiopia: a community-based cross-sectional study.

OBJECTIVES: A lack of safe healthcare waste management (HCWM) practice poses a risk to healthcare staff, patients and communities. In low-income countries like Ethiopia, studies on the level of safe HCWM practices in private healthcare facilities are limited. This study was designed to assess the level of good HCWM practice and associated factors among health workers in private health facilities. METHODS: An institution-based cross-sectional study was conducted in the Ilu Aba Bor zone, South West Ethiopia. A random sample of 282 health workers from 143 private health facilities was included in the study. Data were collected using a pretested structured questionnaire that included sociodemographic characteristics, healthcare factors, knowledge assessment and an observation checklist adapted from WHO guidelines. The collected data were entered into EpiData V.3.1 and analysed with SPSS V.25.0. Multivariable logistic regression analysis was used to identify factors associated with HCWM practice. Variables with a p value of <0.05 at 95% CI were declared significant. RESULTS: More than half (58.7%) of private-sector health workers had good HCWM practice. The presence of the HCWM committee (adjusted OR (AOR)=9.6, 95% CI 4.5 to 20.6), designated healthcare waste storage site (AOR=3.0, 95% CI 1.5 to 6.5), reading the HCWM manual (AOR=4.4, 95% CI 2.2 to 9.0) and having good knowledge of HCWM (AOR=2.6, 95% CI 1.06 to 6.15) were factors associated with good HCWM practice. CONCLUSION: About three out of five health workers in private healthcare facilities were practising good HCWM. The presence of an HCWM committee, waste management utilities, reading HCWM guidelines and knowledge of health workers were the identified factors. Health workers should read guidelines to improve their knowledge, and the presence of committees and waste management utilities in private clinics should be followed to ensure compliance with safe HCWM practice.