Waste production from phacoemulsification surgery.

PURPOSE: To determine the amount of waste produced from phacoemulsification surgeries and ways to curtail the problem. SETTING: Miri Hospital, Sarawak, Malaysia. DESIGN: Prospective study. METHODS: Phacoemulsification surgery cases were included in this study; nonphacoemulsification surgeries were excluded. The waste was subdivided into 3 main categories, general waste, clinical waste, and sharps. The waste produced by ophthalmologists and trainees was accounted for separately. The mean weight of waste per case was obtained by dividing the total weight of waste produced with the total number of cases. RESULTS: The total waste produced from a total of 203 cases of phacoemulsification surgeries was 167.965 kg, of which, 95.063 kg (56.6%) were clinical waste, 63.197 kg (37.6%) were general waste, and 9.705 kg (5.8%) were sharps; 32.193 kg (50.9%) out of the general waste pool were recyclable waste products. The mean waste production per case of phacoemulsification surgery for an ophthalmologist was 0.814 kg, 1.086 kg per case for a trainee. A case of phacoemulsification surgery would produce 0.282 kg of carbon dioxide equivalents in the setup based on the recyclable general waste. CONCLUSIONS: The average waste produced per case of phacoemulsification surgery in Miri Hospital was 0.827 kg. After excluding the recyclable material, the average waste produced per case was 0.669 kg. Following the 3 R's principles (reduce, reuse, and recycle) in the handling of waste production might reduce environmental impact.

An Anesthesia Attempt to Be Green: How Do You Waste Your Carbon Dioxide Absorbers?

Operating room waste is categorized as noncontaminated solid waste (SW) and regulated medical waste (RMW). RMW is treated by autoclaving at an increased economic and environmental cost. We evaluated these costs with a focus on the disposable carbon dioxide (CO2) absorbers. At our institution, exhausted CO2 absorbers were discarded as RMW. We collaborated with product representatives, anesthesia and perioperative staff, and waste management personnel to identify opportunities and barriers for recycling and waste reduction. Ultimately, we agreed to discard CO2 absorbers as SW instead of RMW, a strategy that is practical, less expensive, and more environmentally appropriate.

Improved Biosafety and Biosecurity Measures and/or Strategies to Tackle Laboratory-Acquired Infections and Related Risks.

Herein, we reviewed laboratory-acquired infections (LAIs) along with their health-related biological risks to provide an evidence base to tackle biosafety/biosecurity and biocontainment issues. Over the past years, a broad spectrum of pathogenic agents, such as bacteria, fungi, viruses, parasites, or genetically modified organisms, have been described and gained a substantial concern due to their profound biological as well as ecological risks. Furthermore, the emergence and/or re-emergence of life-threatening diseases are of supreme concern and come under the biosafety and biosecurity agenda to circumvent LAIs. Though the precise infection risk after an exposure remains uncertain, LAIs inspections revealed that Brucella spp., Mycobacterium tuberculosis, Salmonella spp., Shigella spp., Rickettsia spp., and Neisseria meningitidis are the leading causes. Similarly, the human immunodeficiency virus (HIV) as well as hepatitis B (HBV) and C viruses (HCV), and the dimorphic fungi are accountable for the utmost number of viral and fungal-associated LAIs. In this context, clinical laboratories at large and microbiology, mycology, bacteriology, and virology-oriented laboratories, in particular, necessitate appropriate biosafety and/or biosecurity measures to ensure the safety of laboratory workers and working environment, which are likely to have direct or indirect contact/exposure to hazardous materials or organisms. Laboratory staff education and training are indispensable to gain an adequate awareness to handle biologically hazardous materials as per internationally recognized strategies. In addition, workshops should be organized among laboratory workers to let them know the epidemiology, pathogenicity, and human susceptibility of LAIs. In this way, several health-related threats that result from the biologically hazardous materials can be abridged or minimized and controlled by the correct implementation of nationally and internationally certified protocols that include proper microbiological practices, containment devices/apparatus, satisfactory facilities or resources, protective barriers, and specialized education and training of laboratory staffs. The present work highlights this serious issue of LAIs and associated risks with suitable examples. Potential preventive strategies to tackle an array of causative agents are also discussed. In this respect, the researchers and scientific community may benefit from the lessons learned in the past to anticipate future problems.

A pilot survey of the U.S. medical waste industry to determine training needs for safely handling highly infectious waste.

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

Geração de resíduos odontológicos de diferentes especialidades clínicas / Generation of dental waste during different clinical specialties

Objetivo: Investigar a massa de resíduos de serviços de saúde (RSS) de origem odontológica produzida com o atendimento clínico de diferentes especialidades em instituição de ensino público no estado de São Paulo. Material e método: Foram pesados os RSS de origem odontológica gerados nas diferentes clínicas da Faculdade de Odontologia assim como anotados os procedimentos odontológicos aplicados em cada atendimento em formulário específico. Resultado: Ao total foram pesquisadas 10 especialidades odontológicas, com a realização de 229 atendimentos e peso médio por atendimento de 166,62 g de RSS odontológicos. Observou-se um número médio de 1,17 a 2,83 de procedimentos por atendimento e que o peso médio por atendimento por especialidade variou entre 84,08 e 387,39 g, sendo que as especialidades que mais geraram RSS odontológicos foram às relacionadas à prática de cirurgia, enquanto que a especialidade que menos gerou massa de resíduos foi a Odontopediatria. Dos 133 procedimentos utilizados na Faculdade de Odontologia, 39 procedimentos foram isolados a partir dos atendimentos que aplicaram apenas um procedimento. Gerou-se um índice de potencial de geração de RSS odontológicos para cada um destes 39 procedimentos e verificou-se que o procedimento "exodontia de dente permanente" apresentou o maior potencial de geração de RSS. Observou-se que os estudantes de Odontologia focavam mais na segurança do paciente do que na observância da destinação dos RSS gerados. Conclusão: Constatou-se com a presente pesquisa que na ausência de um plano de gerenciamento de RSS na instituição, há a possibilidade de uma produção exagerada de RSS odontológico na Universidade(AU)

Objective: To investigate the mass of dental waste produced within different specialties of clinical care in a public education institution in the state of São Paulo. Material and method: The researcher weighed the waste of dental origin generated in the different clinics of the Faculty of Dentistry as well as noted the dental procedures applied in each attendance in a specific form. Results: A total of 10 dental specialties were studied, with 229 consultations and average weight per clinical care of 166.62 g of dental waste. It was observed that the average number of procedures performed by specialty care varied between 1.17 and 2.83 and that the average weight per clinical care per specialty varied between 84.08 and 387.39 g, and the specialties that generated the most dental waste were those related to the practice of surgery, while the specialty that generated less mass was the Pediatric Dentistry. 39 of the 133 procedures were isolated among those clinical cares that applied only one procedure. An index of potential dental waste generation was calculated for each of these 39 procedures and it was verified that the procedure "permanent tooth exodontia" presented the greatest potential of waste generation. It was observed that dentistry students focused more on patient safety than on observing the destination of dental waste generated. Conclusion: It was verified with the present research that in the absence of a dental waste management plan in the institution, there is the possibility of an overproduction of odontological waste in the University(AU)

Nivel de conocimiento sobre manejo de desechos estomatológicos / Level of knowledge about stomatological waste management

Se realizó un estudio descriptivo transversal con el objetivo de determinar el nivel de conocimiento sobre el manejo de los desechos de Estomatología en el personal técnico y profesional de la Clínica Docente Julio Antonio Mella de la provincia Guantánamo. El universo estuvo constituido por 26 compañeros que mostraron disposición en llenar el cuestionario. Se analizaron los conocimientos sobre manejo de los desechos de Estomatología: (conocimiento sobre clasificación de los desechos para su segregación, etapas de manejo de desechos, desechos en la basura para la recogida por comunales, que hacer en caso de derrame de mercurio, actualización del Plan de Manejo y evaluación en general de los conocimientos). Se realizó una exhaustiva revisión bibliográfica sobre el tema con literaturas universales y nacionales. Los datos primarios se obtuvieron de una planilla encuesta confeccionada por los autores. Solo el 23.1 por ciento de los encuestados mostró un nivel de conocimiento suficiente y el 76.9 por ciento tuvo un nivel de conocimiento insuficiente(AU)

A descriptive cross - sectional study was carried out to determine the level of knowledge about the management of Stomatology waste in the technical and professional staff of the Julio Antonio Mella Clinic in Guantanamo province. The universe was constituted by 26 companions who showed willingness to fill out the questionnaire. Knowledge about waste management in stomatology was analyzed: (knowledge about classification of waste for segregation, stages of waste management, waste in trash for community collection, what to do in case of mercury spill, Management Plan and general assessment of knowledge). An exhaustive bibliographical review on the subject was carried out with universal and national literatures. The primary data were obtained from a survey sheet prepared by the authors. Only 23.1 percent of the respondents showed a sufficient level of knowledge and 76.9 percent had an insufficient level of knowledge(AU)

Medical waste management - A review.

This paper examines medical waste management, including the common sources, governing legislation and handling and disposal methods. Many developed nations have medical waste legislation, however there is generally little guidance as to which objects can be defined as infectious. This lack of clarity has made sorting medical waste inefficient, thereby increasing the volume of waste treated for pathogens, which is commonly done by incineration. This review highlights that the unnecessary classification of waste as infectious results in higher disposal costs and an increase in undesirable environmental impacts. The review concludes that better education of healthcare workers and standardized sorting of medical waste streams are key avenues for efficient waste management at healthcare facilities, and that further research is required given the trend in increased medical waste production with increasing global GDP.

Gestión de los residuos sanitarios en el ámbito hospitalario. Nivel de conocimiento y valoración Global / Sanitary waste in the hospital setting: Knowledge level and overall rating

Los residuos sanitarios representan un peligro potencial para los trabajadores sanitarios. Dado el alto riesgo de infección en los accidentes laborales, la gestión correcta de los residuos sanitarios minimiza el riesgo y mejora las condiciones laborales y ambientales. Objetivos. Identificar el nivel de conocimiento que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS) y valorar de forma global la gestión de los mismos. Metodología. Estudio descriptivo transversal con 178 participantes (auxiliares, enfermeras, médicos y técnicos de laboratorio), de 3 hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, que analizabalas variables laborales, el conocimiento y la valoración global de la gestión de los RS. Resultados. El nivel medio de conocimiento sobre los RS delos auxiliares, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (valor mínimo) a 15 (valor máximo), es de 10.59, 10.61, 8.92 y 8.39, respectivamente. La valoración global que hacen los auxiliares, las enfermeras, los médicos y los técnicos de laboratorio de la gestión de los RS en una escala de 1 (valor mínimo) y 5 (valor máximo), es de 2.89, 2.93, 2.88, 2.94, respectivamente. Conclusiones. Los resultados sugieren que las enfermeras y los auxiliares tienen un nivel de conocimiento aceptable con respecto a la gestión correcta de los RS. En cambio, los médicos y técnicos de laboratorio tienen un nivel de conocimiento inferiorsobre la segregación y eliminación adecuada de los RS. En cuanto a la valoración global, se obtienen valores aceptables, y muy similares, entre las diferentes categorías de profesionales estudiadas, en relación con la gestión correcta de los RS en los centros asistenciales donde realizan su actividad laboral (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. The current study was aimed at identifying the knowledge that health workers have about classification and management of sanitary waste. Methodology. The current study is a descriptive, cross-sectional study of 178 health workers (physicians, nurses, nurse assistants, lab technicians) of 3 hospitals in Barcelona. Results. Using a score from 1 (minimum) to 15 (maximum) to assess the knowledge, the average value for nurse assistants, nurses, physicians and lab technicians was 10.59, 10.61, 8.92 and 8.39, respectively. The global assessment of sanitary waste management (using a score from 1 to 5) was 2.89, 2.93, 2.88 and 2.94, respectively. Conclusions. These results suggest that nurses and nurse assistants have a good level of knowledge about the management of sanitary waste. By contrast, physicians and laboratory technicians have a lower level of knowledge compared to nurses and nurse asistants in relation to segregation and disposal of sanitary waste. Concerning the global assessment, the level is good, without differences between the different categories of health workers (AU)

[PRIORITY TECHNOLOGIES OF THE MEDICAL WASTE DISPOSAL SYSTEM].

The annual production of waste in health care institutions (HCI) tends to increase because of the growth of health care provision for population. Among the many criteria for selecting the optimal treatment technologies HCI is important to provide epidemiological and chemical safety of the final products. Environmentally friendly method of thermal disinfection of medical waste may be sterilizators of medical wastes intended for hospitals, medical centers, laboratories and other health care facilities that have small and medium volume of processing of all types of waste Class B and C. The most optimal method of centralized disposal of medical waste is a thermal processing method of the collected material.

Applying Nightingale charts to evaluate the heterogeneity of biomedical waste in a Hospital.

OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables.

Clasificación de materiales plásticos sanitarios desechables y búsqueda de alternativas sin policloruro de vinilo en el Hospital Virgen de las Nieves / Classification of disposable medical plastics and search for alternatives without polyvinyl chloride in the Hospital Virgen de las Nieves (Granada, Spain)

Objetivos. identificación y clasificación de los productos hospitalarios desechables que contengan policloruro de vinilo (PVC), integrando la búsqueda y valoración de productos alternativos libres de PVC sustentables desde un punto de vista coste/efectivo. Métodos. análisis de tipo descriptivo observacional. Se realizó en primer lugar una clasificación de los trabajos de investigación más recientes en las principales bases de datos. Seguidamente, se clasificaron los productos desechables susceptibles de contener PVC, dividiéndolos en 5 grupos: cánulas, sondas, tubos, bolsas y equipos enmarcados en el periodo de consumo 2008-2009, diferenciando la valoración técnica y económica de los materiales. Resultados. en el estudio se observa que de los 492 artículos analizados en su composición, 234 (47,5%) contienen PVC y las alternativas libres del compuesto conforman el 19,4%, siendo viable económicamente solo el 11,3% de las alternativas valoradas. Conclusiones. la investigación aclara las ventajas derivadas de la clasificación de productos con PVC, existiendo alternativas seguras y eficientes para algunas líneas de productos, en consonancia con la seguridad de los pacientes y la calidad en el trabajo por parte de los facultativos (AU)

Objectives. To identify and classify disposable hospital products containing polyvinyl chloride (PVC), including the search and evaluation of cost-effective sustainable alternative products free of PVC. Methods. A descriptive observational analysis was performed, after classifying the latest research in major databases, and disposable products that could contain PVC. These were divided into 5 groups: cannulas, catheters, tubes, bags, and equipment, purchased in the period 2008-2009, differentiating between the technical and economic assessment of the materials. Results. In the analysis of the composition of 492 articles selected, 234 (47.5%) contained PVC, and 19.4% were considered PVC-free alternatives, with only 11.3% of these being economically viable. Conclusions. This study highlights the advantages of the classification of PVC products, by showing that safe and efficient alternatives exist for some product lines that are consistent with patient safety and quality in the work by doctors (AU)

Composition and production rate of pharmaceutical and chemical waste from Xanthi General Hospital in Greece.

The objective of this work was to determine the composition and production rates of pharmaceutical and chemical waste produced by Xanthi General Hospital in Greece (XGH). This information is important to design and cost management systems for pharmaceutical and chemical waste, for safety and health considerations and for assessing environmental impact. A total of 233 kg pharmaceutical and 110 kg chemical waste was collected, manually separated and weighed over a period of five working weeks. The total production of pharmaceutical waste comprised 3.9% w/w of the total hazardous medical waste produced by the hospital. Total pharmaceutical waste was classified in three categories, vial waste comprising 51.1%, syringe waste with 11.4% and intravenous therapy (IV) waste with 37.5% w/w of the total. Vial pharmaceutical waste only was further classified in six major categories: antibiotics, digestive system drugs, analgesics, hormones, circulatory system drugs and "other". Production data below are presented as average (standard deviation in parenthesis). The unit production rates for total pharmaceutical waste for the hospital were 12.4 (3.90) g/patient/d and 24.6 (7.48) g/bed/d. The respective unit production rates were: (1) for vial waste 6.4 (1.6) g/patient/d and 13 (2.6) g/bed/d, (2) for syringe waste 1.4 (0.4) g/patient/d and 2.8 (0.8) g/bed/d and (3) for IV waste 4.6 (3.0) g/patient/d and 9.2 (5.9) g/bed/d. Total chemical waste was classified in four categories, chemical reagents comprising 18.2%, solvents with 52.3%, dyes and tracers with 18.2% and solid waste with 11.4% w/w of the total. The total production of chemical waste comprised 1.8% w/w of the total hazardous medical waste produced by the hospital. Thus, the sum of pharmaceutical and chemical waste was 5.7% w/w of the total hazardous medical waste produced by the hospital. The unit production rates for total chemical waste for the hospital were 5.8 (2.2) g/patient/d and 1.1 (0.4) g/exam/d. The respective unit production rates were: (1) for reagents 1.7 (2.4) g/patient/d and 0.3 (0.4) g/examination/d, (2) for solvents 248 (127) g/patient/d and 192 (101) g/examination/d, (3) for dyes and tracers 4.7 (1.4) g/patient/d and 2.5 (0.9) g/examination/d and (4) for solid waste 54 (28) g/patient/d and 42 (22) g/examination/d.

[Biological, chemical, and radiation factors in the classification of medical waste].

The current classification of medical waste does not consider the sanitary-and-chemical hazard of epidemiologically dangerous and extremely dangerous medical waste (classes B and C). According to the results of the studies performed, the authors propose the improved classification of medical waste, which makes it possible to take into account not only infectious, radiation, and toxicological, but also sanitary-and-chemical hazards (toxicity, carcinogenicity, mutagenicity, and biological activity) of medical waste.

Statistical analysis of waste generation in healthcare services: a case study.

In the present study, the amounts of medical waste materials, sharps, liquid waste, hazardous waste, household waste and recyclables generated from 375 healthcare services including private hospitals, state hospitals, university hospitals, private medical centres, dialysis centres, cottage hospitals and private dentist surgeries were determined, and the relation between the amount of the waste and the bed capacities, inpatient and outpatient numbers were evaluated. The amount of regulated medical waste corresponded to 28.8% of the total waste streams collected from the healthcare services, and the major producers were private hospitals. The major producers of hazardous waste were state hospitals with a generation rate of 57.9%. The main results of the study indicate that the quantities of the waste streams generated from healthcare services in accordance with the outpatient number gave more appropriate results than the other evaluation methods. Furthermore, evaluation based on the bed capacities gave reasonable results except for recyclables and hazardous waste. As a result of the evaluation of the medical waste generation rate with bed capacities, the generation rate was determined as 2.11 ± 3.83 kg bed(-1) day(-1) and this rate was 1.45 ± 9.84 kg outpatient(-1) day(-1) for the evaluation by outpatient numbers. The observed significant P values (P > 0.05) indicate that the evaluation of the waste streams in healthcare services based upon outpatient numbers did not show any reasonable change according to service category.