Pharmaceuticals wastage and pharmaceuticals waste management in public health facilities of Dessie town, North East Ethiopia.

BACKGROUND: Pharmaceuticals wastes are drugs and medicines that can no longer be used. The improper disposal of unused medicines is a growing problem throughout the world. This study assessed the pharmaceutical wastage rate and pharmaceutical waste management for the year 2015 to 2017 in the public health facility of Dessie, Ethiopia. METHODOLOGY: A cross-section study design was used to review logistic data retrospectively from health commodity management information systems and manual records in 8 health facilities. Health professionals' (135) pharmaceutical waste management practices were assessed using the world health organization waste management checklist. Descriptive and inferential statistics were made using a statistical package for social sciences version 20. RESULT: Supplies were the leading class of pharmaceuticals with an overall wastage rate of 37.1%. Tablet and injectable constituted the highest class of pharmaceuticals dosage form with the overall wastage rate of 20.78% and 16.49%. The overall pharmaceutical wastage rate was 3.68% amounting to USD 159,762.66 and expiry (92.05%) was the major reason for wastage. The pharmaceutical wastage rate of health centers was nearly twofold higher than hospitals. Pharmaceutical waste management was practiced by 105 (77%; 95% CI; 69.9%, 84.9%) health professionals. Determinants of pharmaceutical waste management were being male (P value = 0.08, AOR = 3.72), receiving training (P value = 0.01, AOR = 4.34), writing label (P value = 0.02, AOR = 5.04), storage of segregated waste in dispensing unit (P value = 0.01, AOR = 0.72) and the presence of disposal plan (P value = 0.002, AOR = 16.93). CONCLUSIONS: Supplies and tablets constituted the highest wastage class of pharmaceuticals and dosage form. The pharmaceutical wastage rate was higher than the standard and increasing in successive years. Pharmaceutical waste management was not fully practiced. Appropriate inventory control and waste management are recommended.

Surveillance and Sequestration Strategies to Reduce the Likelihood of Transporting Highly Pathogenic Avian Influenza Virus Contaminated Layer Manure.

Movement and land application of manure is a known risk factor for secondary spread of avian influenza viruses. During an outbreak of highly pathogenic avian influenza (HPAI), movement of untreated (i.e., fresh) manure from premises known to be infected is prohibited. However, moving manure from apparently healthy (i.e., clinically normal) flocks may be critical, because some egg-layer facilities have limited on-site storage capacity. The objective of this analysis was to evaluate targeted dead-bird active surveillance real-time reverse transcriptase polymerase chain reaction (rRT-PCR) testing protocols that could be used for the managed movement of manure from apparently healthy egg-layer flocks located in an HPAI control area. We also evaluated sequestration, which is the removal of manure from any contact with chickens, or with manure from other flocks, for a period of time, while the flock of origin is actively monitored for the presence of HPAI virus. We used stochastic simulation models to predict the chances of moving a load of contaminated manure, and the quantity of HPAI virus in an 8 metric ton (8000 kg) load of manure moved, before HPAI infection could be detected in the flock. We show that the likelihood of moving contaminated manure decreases as the length of the sequestration period increases from 3 to 10 days (e.g., for a typical contact rate, with a sample pool size of 11 swabs, the likelihood decreased from 48% to <1%). The total quantity of feces from HPAI-infectious birds in a manure load moved also decreases. Results also indicate that active surveillance protocols using 11 swabs per pool result in a lower likelihood of moving contaminated manure relative to protocols using five swabs per pool. Simulation model results from this study are useful to inform further risk evaluation of HPAI spread through pathways associated with manure movement and further evaluation of biosecurity measures intended to reduce those risks.

Artículo regular­Estrategias de vigilancia y aislamiento para reducir la probabilidad de transportar gallinaza de aves de postura contaminada con virus de influenza aviar altamente patógeno. El movimiento y la aplicación de gallinaza a la tierra es un factor de riesgo conocido para la propagación secundaria de los virus de la influenza aviar (IA). Durante un brote de influenza aviar altamente patógena (IAAP), se prohíbe el movimiento de gallinaza sin tratar (es decir, fresco) de las instalaciones que se conoce que están infectadas. Sin embargo, el traslado de gallinaza de parvadas aparentemente sanas (es decir, clínicamente normales) puede ser fundamental, porque algunas instalaciones de producción de huevo tienen una capacidad limitada de almacenamiento en el lugar. El objetivo de este análisis estaba evaluar los protocolos de la prueba de transcriptasa reversa y reacción en cadena de la polimerasa en tiempo real (rRT-PCR) utilizados en la vigilancia activa dirigida a aves muertas, que podrían usarse para el movimiento controlado de gallinaza de parvadas de postura aparentemente sanas ubicadas en un área de control para influenza aviar de alta patogenicidad. También se evaluó el aislamiento, que es la remoción de gallinaza y prevenir cualquier contacto con pollos, o con gallinaza de otras parvadas, durante un período de tiempo, mientras que la parvada de origen es monitoreada activamente para detectar la presencia del virus de la influenza aviar altamente patógeno. Se utilizaron modelos de simulación estocástica para predecir las posibilidades de trasladar una carga de estiércol contaminado y la cantidad de virus de la influenza aviar altamente patógeno en una carga de ocho toneladas métricas (8000 kg) de gallinaza trasladada, antes de que se pudiera detectar la infección por influenza aviar altamente patógena en la parvada. Se demostró que la probabilidad de mover gallinaza contaminada disminuye a medida que la duración del período de aislamiento aumenta de tres a diez días (por ejemplo, para una tasa de contacto típica, con un tamaño de muestra de 11 hisopos, la probabilidad disminuyó de 48% a <1 %). La cantidad total de heces de aves infectadas por la influenza aviar altamente patógena en una carga de gallinaza transportada también disminuye. Los resultados también indican que los protocolos de vigilancia activa que utilizan 11 hisopos como muestra agrupada dan como resultado una menor probabilidad de mover gallinaza contaminada en comparación con los protocolos que utilizan cinco hisopos por muestra agrupada. Los resultados del modelo de simulación de este estudio son útiles para una evaluación adicional del riesgo de la propagación de la influenza aviar altamente patógena a través de vías asociadas con el movimiento de gallinaza y una evaluación adicional de las medidas de bioseguridad destinadas a reducir esos riesgos.

Mercury hygiene and biomedical waste management practices among dental health-care personnel in public hospitals in Lagos State, Nigeria.

BACKGROUND: Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries. OBJECTIVES: This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria. METHODS: A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was conducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were distributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value < 0.05 indicating significant level. RESULTS: Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25-34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040). CONCLUSION: A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria.

Awareness and knowledge of COVID-19 infection control precautions and waste management among healthcare workers: Saudi cross-sectional study.

ABSTRACT: Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs' Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities.

Opportunities for improving opioid disposal practices in the Veterans Health Administration.

PURPOSE: The potentially vast supply of unused opioids in Americans' homes has long been a public health concern. We conducted a needs assessment of how Veterans Affairs (VA) facilities address and manage disposal of unused opioid medications to identify opportunities for improvement. METHODS: We used rapid qualitative content analysis methods with team consensus to synthesize findings. Data were collected in 2 waves: (1) semistructured interviews with 19 providers in October 2019 and (2) structured questions to 21 providers in March to April of 2020 addressing how coronavirus disease 2019 (COVID-19) changed disposal priorities. RESULTS: While many diverse strategies have been tried in the VA, we found limited standardization of advice on opioid disposal and practices nationally. Providers offered the following recommendations: target specific patient scenarios for enhanced disposal efforts, emphasize mail-back envelopes, keep recommendations to providers and patients consistent and reinforce existing guidance, explore virtual modalities to monitor disposal activity, prioritize access to viable disposal strategies, and transition from pull to push communication. These themes were identified in the fall of 2019 and remained salient in the context of the COVID-19 pandemic. CONCLUSION: A centralized VA national approach could include proactive communication with patients and providers, interventions tailored to specific settings and populations, and facilitated access to disposal options. All of the above strategies are feasible in the context of an extended period of social distancing.

Guidelines for Patient-CenteredOpioid Prescribing and Optimal FDA-Compliant Disposal of Excess Pills after Inpatient Operation: Prospective Clinical Trial.

BACKGROUND: To optimize responsible opioid prescribing after inpatient operation, we implemented a clinical trial with the following objectives: prospectively validate patient-centered opioid prescription guidelines and increase the FDA-compliant disposal rate of leftover opioid pills to higher than currently reported rates of 20% to 30%. STUDY DESIGN: We prospectively enrolled 229 patients admitted for 48 hours or longer after elective general, colorectal, urologic, gynecologic, or thoracic operation. At discharge, patients received a prescription for both nonopioid analgesics and opioids based on their opioid usage the day before discharge: if 0 oral morphine milligram equivalents (MME) were used, then five 5-mg oxycodone pill-equivalents were prescribed; if 1 to 29 MME were used, then fifteen 5-mg oxycodone pill-equivalents were prescribed; if 30 or more MME were used, then thirty 5-mg oxycodone pill-equivalents were prescribed. We considered patients' opioid pain medication needs to be satisfied if no opioid refills were obtained. To improve FDA-compliant disposal of leftover pills, we implemented patient education, convenient drop-box, reminder phone call, and questionnaire. RESULTS: Our opioid guideline satisfied 93% (213 of 229) of patients. Satisfaction was significantly higher in lower opioid usage groups (p = 0.001): 99% (99 of 100) in the 0 MME group, 90% (91 of 101) in the 1 to 29 MME group, and 82% (23 of 28) in the 30 or more MME group. Overall, 95% (217 of 229) of patients used nonopioid analgesics. Sixty percent (138 of 229) had leftover pills; 83% (114 of 138) disposed of them using an FDA-compliant method and 51% (58 of 114) used the convenient drop-box. Of 2,604 prescribed pills, only 187 (7%) were kept by patients. CONCLUSIONS: This clinical trial prospectively validated a patient-centered opioid discharge prescription guideline that satisfied 93% of patients. FDA-compliant disposal of excess pills was achieved in 83% of patients with easily actionable interventions.

Healthcare Waste Management Practice and Associated Factors among Private and Public Hospitals of Bahir Dar City Administration.

Background: Lack of an appropriate management practice of healthcare waste is a potential threat to the healthcare workers, patients, and nearby communities of the health institutions. Objective: The study aimed to assess the healthcare waste management practices (HCWMP) and associated factors among healthcare workers of private and public hospitals of Bahir Dar city administration, Ethiopia. Methods: A facility-based comparative cross-sectional study was conducted from January 2016 to April 2017. The systematic random sampling technique was employed to recruit 460 healthcare workers. The collected data entered into the EpiData software (version 3.1). The analysis was done by using SPSS software (version 20). Descriptive statistics were computed; logistic regression model was run. The model fitness was checked using Hosmer and Lemeshow goodness of fit (p > 0.05). A p value of <0.2 at univariate analysis was included in the multivariable logistic regression analysis. Variables with a p value of <0.05 were statistically associated with healthcare waste management practice at 95% CI (AOR). Results: A total of 418 healthcare workers who participated in the study yielded a response of 90.9%. About 65% (95% CI: 61, 70) of the total respondents had good practice of healthcare waste management. More private hospitals, 79.2% (95% CI: 73, 85), had good healthcare waste management practice compared to public hospitals, 53.5% (95% CI: 47, 60). Male healthcare workers (AOR = 6. 43, 95% CI: 1.82, 22.77) and having a functional healthcare waste management committee (AOR = 6. 47, 95%CI: 1.93, 21.76) were significantly associated with HCWMP at private hospitals. For public hospitals, having a healthcare waste management committee (AOR = 1. 80, 95% CI: 1.03, 3.15) and a manual/guideline on HCWMP (AOR = 2. 43, 95% CI: 1.20, 4.91) was significantly associated with HCWMP. Conclusions: This study revealed there is a great discrepancy in HCWMP between private and public hospitals. Male healthcare workers and having a functional healthcare waste management committee and a manual/guideline were the identified factors of HCWMP.

[Ethics and confidentiality of a patient in a medical biology laboratory]. / L'éthique et la confidentialité du patient au laboratoire de biologie médicale.

Confidentiality is based on principles of deontology and ethics, which are included in French regulations and supported by the professional orders. It contributes to the respect and dignity of the patient. If this consideration of the human person is old, it has been updated to build the framework imposed by the accreditation of medical biology laboratories. Confidentiality is thus reflected in a charter of ethics, a model of which we propose here. It reflects the commitments of healthcare professionals in the processing of biological samples from patients. Confidentiality is thus applied, in a practical way, at each phase of the laboratory's activity. In the pre-analytical phase, it organizes the reception of the patient and the taking of samples, taking into account the particular case of minors. In the analytical phase, confidentiality imposes limited access to the technical premises and the organization of the flow of personnel from outside the laboratory. Finally, in the post-analytical phase, the reporting of results is regulated, depending on the type of analyses performed and the person to whom the results are to be reported (patient or prescriber). The particular case of spermiology illustrates all these points. Finally, during these phases of sample processing, document management is also a matter of confidentiality and data protection. Confidentiality is essential to the functioning of a health care structure, but it is restrictive in its day-to-day implementation. Nevertheless, it must be combined with an awareness of all staff to address the ethical issue of human dignity.

Face masks. Technical, technological and functional characteristics and hygienic-sanitary aspects related to the use of filtering mask in the community.

INTRODUCTION: The health emergency caused by the spread of SARS-COV-2 virus has required the adoption of passive measures against contagion, such as social distancing. The use of filtering masks, of the different types available on the market, such as surgical and facial filtering masks (FFP1, FFP2 and FFP3), is also recommended. OBJECTIVES: The aim of this paper, within the Italian and European regulatory reference framework, is to suggest a rational application of existing methodologies that enable to know and assess the features and/or make a face mask intended to be used by the community. In addition to this, the study aims to provide a correct regulatory framework and useful information for a correct use and disposal of face masks. Another purpose is the assessment of the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. METHODS: The analysis of filtering masks is based on the review of scientific literature, the state of art of technology and the filtering means/materials available. Reference is made to filtering mechanisms and devices, the testing methods, the technical, manufacturing and performance features, and to the Italian and European regulatory reference framework. Reference is also made to the hygienic, sanitary and regulatory aspects related to the use and disposal of face masks. RESULTS: Surgical masks or, alternatively, filtering masks with a filtration efficiency between 90% and 95% for 3-µm particles, are the most practicable choice with minor contraindications. The reusable type of mask is conceptually superior compared to single-use masks, but cleaning procedures to be followed are quite complex and not always described in a clear way. CONCLUSIONS: The definition of rigorous and repeatable tests on mask filtration capacity, breathability, wearability, duration of use, regeneration, as well as safe disposal methods, are the main way to provide users with correct selection and use criteria. The results must be disclosed and disseminated quickly.

AEG-SEED position paper for the resumption of endoscopic activity after the peak phase of the COVID-19 pandemic. / Documento de posicionamiento AEG-SEED para el reinicio de la actividad endoscópica tras la fase pico de la pandemia de COVID-19.

INTRODUCTION: The COVID-19 pandemic has led to the suspension of programmed activity in most of the Endoscopy Units in our environment. The aim of this document is to facilitate the resumption of elective endoscopic activity in an efficient and safe manner. MATERIAL AND METHODS: A series of questions considered to be of clinical and logistical relevance were formulated. In order to elaborate the answers, a structured bibliographic search was carried out in the main databases and the recommendations of the main Public Health and Digestive Endoscopy institutions were reviewed. The final recommendations were agreed upon through telematic means. RESULTS: A total of 33 recommendations were made. The main aspects discussed are: 1) Reassessment and prioritization of the indication, 2) Restructuring of spaces, schedules and health personnel, 3) Screening for infection, 4) Hygiene measures and personal protective equipment. CONCLUSION: The AEG and SEED recommend restarting endoscopic activity in a phased, safe manner, adapted to local resources and the epidemiological situation of SARS-CoV-2 infection.

Medical waste management practice during the 2019-2020 novel coronavirus pandemic: Experience in a general hospital.

It is currently a critical period for the prevention and control of the COVID-19 pandemic. Since the medical waste disposal could be an important way to control the source of infection, standardization, and strict implementation of the management of COVID-19 related medical waste should be with careful consideration to reduce the risk of epidemic within hospitals. This study illustrates the practice of medical waste disposal responding to the 2019-2020 novel coronavirus pandemic.

COVID-19: The Need for Rational Use of Face Masks in Nigeria.

Because of the pandemic of COVID-19, the federal government of Nigeria has instituted a mandatory policy requiring everyone going out in public to wear face masks. Unfortunately, the Nigeria media is awash with images of misuse and abuse of face masks by the public, government officials, and healthcare workers. Medical masks are used widely in community settings amid reported scarcity within healthcare facilities. It is observed that some people wear face masks on their chin and neck, and mask wearers give no attention to covering their mouth and nose, especially when talking. Used face masks are kept with personal belongings or disposed indiscriminately in public spaces, leading to self and environmental contamination. Inappropriate use and disposal of face masks in Nigeria could promote the spread of the novel coronavirus in the country and negate the country's efforts to contain the COVID-19 pandemic. In the implementation of the universal masking policy in Nigeria, federal and state governments ought to consider local applicability, feasibility, and sustainability, as well as identify and mitigate all potential risks and unintended consequences. Also critical is the need for intensive public sensitization and education on appropriate use and disposal of face masks in the country.

Recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19 / Recommendations for the disinfection of hospital environments exposed to COVID-19

GENERALIDADES: Brindar recomendaciones para la desinfección de ambientes hospitalarios expuestos a COVID-19. Ambientes hospitalarios expuestos a COVID-19.Estas recomendaciones están dirigidas a gerentes o directores de los establecimientos de salud, líderes de equipo de trabajo de salud y personal encargado de la limpieza y desinfección de ambientes, para prevenir problemas de infección por COVID-19. El presente documento es de aplicación en las IPRESS de las Redes Asistenciales, Redes Prestacionales y en los Órganos Prestadores Nacionales, a nivel nacional. MÉTODOS: Búsqueda y selección de protocolos, guías de práctica clínica y documentos técnicos previos. FORMULACIÓN DE LAS RECOMENDACIONES: Para la formulación de las recomendaciones se revisaron pautas y protocolos encontrados que describieron más ampliamente los procedimientos a realizar para la desinfección de ambientes hospitalarios expuestos a COVID-19. Producto del ello se establecieron las recomendaciones. DESARROLLO DE LAS RECOMENDACIONES: Flujograma para la desinfección de ambientes hospitalarios expuestos a COVID-19. El actual surgimiento del nuevo coronavirus (SARS-CoV-2) viene a ser el tercer coronavirus humano altamente patógeno que ha surgido en las últimas dos décadas. Su transmisión entre personas se da en ambientes hospitalarios como en otros, así como superficies secas contaminadas. La información para la inactivación específica para del COVID-19 viene recientemente emergiendo. Sin embargo, estudios actuales evidencian que para la inactivación de coronavirus humanos como el coronavirus del síndrome respiratorio agudo severo (SARS), el coronavirus del síndrome respiratorio del Medio Oriente (MERS) o los coronavirus humanos endémicos (HCoV), la utilización de productos como el etanol, peróxidos de hidrógenos o hipoclorito de sodio, así como otros agentes biocidas utilizados para la desinfección química como el cloruro de benzalconio o el digluconato de clorhexidina son efectivos (3). Por tanto, la contención temprana y la prevención de una mayor propagación serán cruciales para detener el brote en curso y controlar este nuevo hilo infeccioso.

Medical Waste-Sorting and Management Practices in Five Hospitals in Ghana.

Hospital waste management in Ghana faces the risk of cross-contamination from the lack of thorough sorting of the waste at the points of generation, codisposal of hazardous and nonhazardous waste types, and use of open-fire pits and substandard incinerators for burning infectious waste. This has increased the potential for the spread of infections and chemical pollutants. A cross-sectional study was conducted in five hospitals in Ghana to assess behavioral patterns on waste sorting and the effectiveness of hospital waste management in Ghana. A total of 250 questionnaires were distributed purposively to some staff of the five hospitals to assess workers' perceptions on medical waste sorting and handling. Additionally, focused group discussions and transect walks were adopted to examine the current collection, storage, treatment, and disposal methods used in the health facilities. Chi-square analyses showed significant differences in waste-sorting behavior based only on occupation (p < 0.0001, n=180) and not on gender, education, or experience in the health sector. Even though contaminated sharps were separated into brown safety boxes, color coding for other infectious waste containers was inconsistent across the health facilities. The study revealed that incineration is still the modal method of treatment in Ghanaian hospitals and therefore new approaches such as an engineering approach were required to minimize its environmental effects. It is recommended that periodic in-service training workshops be held for healthcare staff on the right source-segregation of medical waste, in order to facilitate the effective and safe handling, transport, treatment, and disposal of waste from health facilities.

Situational Assessment of Functional Elements, Practices Adopted & Concerns Related to Bio Medical Waste Management in City of Pune, India.

The study was conducted with the objective of leading a situational assessment of Pune city with regard to Bio medical waste management, exploring knowledge, attitude & practices (KAP) of healthcare workers, and identifying challenges of stakeholders. Results revealed 69.2% of the hospitals had a biomedical waste management facility. Facilities like incineration, shredder, sharp pit, encapsulation, deep burial, and chemical disinfection were non- existing in 60% to 90% of hospitals. Bivariate analysis on questions with the type of employees and (KAP) was calculated. The utilization of the existing services and noncompliance are the major findings from the study.