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2.
Waste Manag ; 113: 197-209, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32535372

RESUMO

Medical waste generation is rapidly rising, which may cause a serious risk for both humans and environment if it is not properly managed. Designing an efficient and reliable medical waste reverse supply chain (MWRSC) is extremely beneficial to society. Most studies on this issue have only considered the generated waste and have not reported the uncertainty in the amount of medical waste generation and other MWRSC parameters. Sustainability criteria and environmental issues in choosing treatment technology are rarely considered as well. In this research, a linear programming model under uncertainty is developed to design an MWRSC. The proposed model is multi-item and multi-period with three objective functions. The first objective function minimizes total costs, the second objective function is relevant to the best treatment technology selection and the third objective function minimizes the total medical waste stored. A robust possibilistic programming approach is utilized to handle imprecise parameters in the model and a fuzzy goal programming method is employed to build up a multi-objective model. A real case study is conducted to illustrate the potential of the proposed model which involves different attributes and problems, such as the location and capacity of facilities, and the type of treatment technology. Furthermore, the transferring amount of medical waste among different nodes is calculated.


Assuntos
Resíduos de Serviços de Saúde , Gerenciamento de Resíduos , Algoritmos , Setor de Assistência à Saúde , Humanos , Incerteza
4.
Sci Total Environ ; 728: 138870, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32335408

RESUMO

The outbreak of COVID-19 has caused concerns globally. On 30 January WHO has declared it as a global health emergency. The easy spread of this virus made people to wear a mask as precautionary route, use gloves and hand sanitizer on a daily basis that resulted in generation of a massive amount of medical wastes in the environment. Millions of people have been put on lockdown in order to reduce the transmission of the virus. This epidemic has also changed the people's life style; caused extensive job losses and threatened the sustenance of millions of people, as businesses have shut down to control the spread of virus. All over the world, flights have been canceled and transport systems have been closed. Overall, the economic activities have been stopped and stock markets dropped along with the falling carbon emission. However, the lock down of the COVID-19 pandemic caused the air quality in many cities across the globe to improve and drop in water pollutions in some parts of the world.


Assuntos
Infecções por Coronavirus , Meio Ambiente , Pandemias , Pneumonia Viral , Poluição do Ar , Betacoronavirus , Cidades , Comércio/tendências , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Humanos , Resíduos de Serviços de Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Poluição da Água
5.
Artigo em Inglês | MEDLINE | ID: mdl-32182811

RESUMO

The outbreak of an epidemic disease may pose significant treats to human beings and may further lead to a global crisis. In order to control the spread of an epidemic, the effective management of rapidly increased medical waste through establishing a temporary reverse logistics system is of vital importance. However, no research has been conducted with the focus on the design of an epidemic reverse logistics network for dealing with medical waste during epidemic outbreaks, which, if improperly treated, may accelerate disease spread and pose a significant risk for both medical staffs and patients. Therefore, this paper proposes a novel multi-objective multi-period mixed integer program for reverse logistics network design in epidemic outbreaks, which aims at determining the best locations of temporary facilities and the transportation strategies for effective management of the exponentially increased medical waste within a very short period. The application of the model is illustrated with a case study based on the outbreak of the coronavirus disease 2019 (COVID-19) in Wuhan, China. Even though the uncertainty of the future COVID-19 spread tendency is very high at the time of this research, several general policy recommendations can still be obtained based on computational experiments and quantitative analyses. Among other insights, the results suggest installing temporary incinerators may be an effective solution for managing the tremendous increase of medical waste during the COVID-19 outbreak in Wuhan, but the location selection of these temporary incinerators is of significant importance. Due to the limitation on available data and knowledge at present stage, more real-world information are needed to assess the effectiveness of the current solution.


Assuntos
Infecções por Coronavirus/epidemiologia , Surtos de Doenças , Eliminação de Resíduos de Serviços de Saúde , Resíduos de Serviços de Saúde , Pneumonia Viral/epidemiologia , Gerenciamento de Resíduos/métodos , Betacoronavirus , China/epidemiologia , Epidemias , Humanos , Pesquisa Operacional , Resolução de Problemas , Incerteza
6.
Guatemala; MSPAS, Coordinación de Hospitales; 27 mar 2020. graf.
Não convencional em Espanhol | LILACS, LIGCSA | ID: biblio-1096347

RESUMO

Este documento da orientación provisional procura fortalecer la respuesta de los servicios hospitalarios ante la posibilidad de tener casos en el país de COVID-19, especialmente en la parte de prevención de la transmisión a del fortalecimiento de las precauciones estándar para la prevención y control de infecciones, con énfasis en el lavado de manos y el uso de equipo protección personal por parte del personal de salud. Además, provee orientaciones para organizar los servicios hospitalarios para adecuar áreas de aislamiento, cuidados intermedios y áreas de triage. El documento también orienta para la proyección de costos de insumos: Material medico quirúrgico, medicamentos, recursos humanos, entre otros como preparación para la respuesta (AU).


Assuntos
Humanos , Organização e Administração/normas , Pneumonia Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , Betacoronavirus , Assistência ao Paciente/métodos , Cadáver , Preparações Farmacêuticas/economia , Contenção de Riscos Biológicos/normas , Sistema de Vigilância Sanitária , Programa de Controle de Infecção Hospitalar , Guatemala , Resíduos de Serviços de Saúde/prevenção & controle
7.
Rev. SOBECC ; 25(1): 25-32, 31-03-2020.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1096322

RESUMO

Objetivo: Conhecer a relação dos riscos ocupacionais com os resíduos de serviços de saúde (RSS), na perspectiva de profissionais de enfermagem que atuam no centro cirúrgico (CC). Método: Trata-se de uma pesquisa de campo de caráter exploratório e descritivo e abordagem qualitativa. Os dados foram coletados por meio de entrevista gravada, com três questões abertas sobre a geração e o manejo de resíduos e riscos à saúde dos profissionais de enfermagem. A amostra foi composta de 11 técnicos e dois auxiliares de enfermagem. Os dados foram organizados e analisados segundo a proposta do método do discurso do sujeito coletivo (DSC). Resultados: Os discursos revelaram preocupação em realizar o manejo adequado dos resíduos gerados, com destaque para os biológicos e perfurocortantes. Os profissionais compreendem que o não cumprimento de práticas seguras de manejo pode expor prejuízos à própria saúde, à do paciente e à de outros profissionais. Conclusão: Os resultados evidenciaram exposição dos profissionais de enfermagem aos resíduos gerados no CC, o que reforça a necessidade de práticas contínuas de orientações e treinamentos para o manejo apropriado desses resíduos, com a finalidade de minimizar riscos de exposição dos profissionais, dos pacientes e do ambiente.


Objective: To understand the relationship between occupational risks and health care waste (HCW), from the perspective of nursing professionals working in the surgery center (SC). Method: This is exploratory and descriptive field research with a qualitative approach. Data were collected through recorded interviews, with three open questions on the generation and management of waste and health risks to nursing professionals. The sample consisted of 11 technicians and two auxiliary nurses. Data were organized and analyzed according to the collective subject discourse (CSD) method. Results: The speeches revealed concern in adequately managing the generated waste, particularly biological and sharp ones. Professionals understand that failure to comply with safe management practices can lead to damage to their health, that of the patient, and that of other professionals. Conclusion: The results showed the exposure of nursing professionals to the waste generated in the SC, which reinforces the need for ongoing guidance practices and training for the appropriate management of these residues, in order to minimize risks of exposure for professionals, patients, and the environment.


Objetivo: Conocer la relación entre riesgos laborales y los residuoe de los servicios de salud (RSS), desde la perspectiva de los profesionales de enfermería que trabajan en quirófano (CQ). Método: Esta es una investigación de campo exploratoria y descriptiva con un enfoque cualitativo. Los datos se recopilaron mediante entrevistas grabadas, con tres preguntas abiertas sobre la generación y gestión de residuos y riesgos para la salud de los profesionales de enfermería. La muestra consistió en 11 técnicos y dos auxiliares de enfermería. Los datos fueron organizados y analizados de acuerdo con el método del discurso del sujeto colectivo (DSC). Resultados: Los discursos revelaron una preocupación por llevar a cabo el manejo adecuado de los desechos generados, con énfasis en productos biológicos y objetos punzantes. Los profesionales entienden que el incumplimiento de las prácticas de gestión segura puede exponer el daño a su propia salud, la del paciente y la de otros profesionales. Conclusión: Los resultados evidenciaron la exposición de los profesionales de enfermería a los desechos generados en el CQ, lo que refuerza la necesidad de orientación continua y prácticas de capacitación para el manejo adecuado de estos desechos, a fin de minimizar los riesgos de exposición de profesionales, pacientes y medio ambiente


Assuntos
Humanos , Saúde , Enfermagem , Resíduos de Serviços de Saúde , Centros Cirúrgicos , Resíduos Radioativos , Eliminação de Resíduos de Serviços de Saúde , Resíduos Químicos
8.
Am J Nurs ; 120(4): 45-48, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32218047

RESUMO

Since the 1960s, plastic has been used in the production of medical equipment and products that improve patient comfort, safety, and treatment. Yet an unwelcome challenge has emerged in the years since: how to safely dispose of this material without negatively affecting human health and the environment. Working with medical devices and supplies that are constructed using plastics, nurses are at the forefront of this issue and must identify solutions, collaborate with other health care workers, and lead efforts to establish more sustainable options. This series is in collaboration with the Alliance of Nurses for Healthy Environments (https://envirn.org).


Assuntos
Conservação dos Recursos Naturais , Resíduos de Serviços de Saúde/efeitos adversos , Plásticos , Gerenciamento de Resíduos , Assistência à Saúde , Humanos , Recursos Humanos de Enfermagem/organização & administração
9.
Talanta ; 206: 120224, 2020 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-31514858

RESUMO

This paper presents a fast and automatic flow-based method to extract 131I from biological samples and hospital waste, previous to liquid scintillation detection. 131I is a radionuclide extensively used in Nuclear Medicine due to their beta and gamma disintegrations, whereby hospitals have to manage the associated waste generation. The automatic developed system is based on Lab-On-Valve (LOV) flow-technique exploiting Cl-resin (135 mg per extraction). This methodology allows performing sample extractions and measurements on the same day, since the extraction frequency takes 1.4-4 h-1, depending on the analysed sample volume, plus up to 2 h of measurement for each vial. 131I is retained as iodine ion and eluted with sodium sulphide 0.2 mol L-1. The maximum sample volume that can be preconcentrated is 20 mL, reaching an extraction efficiency of 85 ±â€¯5%. The minimum detectable activity (MDA) is 0.05 Bq, showing a precision of 7% RSD (n = 5). Both, biological samples (urine and saliva) and hospital waste samples can be satisfactorily analysed by the proposed system, obtaining recoveries between 90 and 110%. The developed method is then suitable to implement in hospitals, improving the surveillance of the 131I environmental release.


Assuntos
Análise de Injeção de Fluxo/métodos , Hospitais/provisão & distribução , Radioisótopos do Iodo/análise , Resíduos de Serviços de Saúde/análise , Contagem de Cintilação/métodos , Humanos , Radioisótopos do Iodo/urina , Saliva/química
10.
Chemosphere ; 239: 124839, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31726519

RESUMO

The inhalational anaesthetic agent - sevoflurane is widely employed for the induction and maintenance of surgical anaesthesia. Sevoflurane possesses a high global warming potential that imposes negative impact to the environment. The only way to resolve the issue is to remove sevoflurane from the medical waste gas before it reaches the atmosphere. A continuous adsorption study with a fixed-bed column was conducted using two commercial granular activated carbons (E-GAC and H-GAC), to selectively remove sevoflurane. The effect of bed depth (Z, 5-15 cm), gas flow rate (Q, 0.5-6.0 L/min) and inlet sevoflurane concentration (C0, ∼55-700 mg/L) was investigated. E-GAC demonstrated ∼60% higher adsorption capacity than H-GAC under the same operating conditions. Varying the levels of Z, Q and C0 showed significant differences in the adsorption capacities of E-GAC, whereas only changing the C0 level had significant differences for H-GAC. Three breakthrough models (Adams-Bohart, Thomas, and Yoon-Nelson) and Bed-depth/service time (BDST) analysis were applied to predict the breakthrough characteristics of the adsorption tests and determine the characteristic parameters of the column. The Yoon-Nelson and Thomas model-predicted breakthrough curves were in good agreement with the experimental values. In the case of the Adams-Bohart model, a low correlation was observed. The predicted breakthrough time (tb) based on kinetic constant (kBDST) in BDST analysis showed satisfactory agreement with the measured values. The results suggest the possibility of designing, scaling up and optimising an adsorption system for removing sevoflurane with the aid of the models and BDST analysis.


Assuntos
Poluentes Atmosféricos/análise , Anestésicos Inalatórios/análise , Carvão Vegetal/química , Eliminação de Resíduos de Serviços de Saúde/métodos , Resíduos de Serviços de Saúde/análise , Sevoflurano/análise , Adsorção
12.
Environ Monit Assess ; 192(1): 10, 2019 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-31807921

RESUMO

Medical wastes are considered hazardous because they may possess infectious agents and can cause unsafe effects on the environment and human health. This study is to analyze and evaluate the current status of medical waste management at Jenin's district in light of medical waste control regulations recommended by the World Health Organization. The results demonstrated that the average hazardous healthcare waste generation rate ranges from 0.54 to 1.82 kg/bed/day with a weighted average of 0.78 kg/bed/day. There was no established waste segregation of healthcare waste types in all hospitals, and these wastes were finally disposed of in a centralized municipal sanitary landfill, namely Zahrat Al-Finjan. The results suggest that there is a need for activation and enforcement of medical waste laws. This can be achieved through cooperation among key actors: Ministry of Health, Environmental Quality Authority, Ministry of Local Government, and Non-Governmental Organizations working in related fields. Additional remediation measures proposed to tackle the problematic areas of medical waste management in Jenin's district hospitals are addressed. Some recommendations to minimize potential health and environmental risks of medical waste are also introduced.


Assuntos
Hospitais , Eliminação de Resíduos de Serviços de Saúde/métodos , Resíduos de Serviços de Saúde , Gerenciamento de Resíduos/métodos , Monitoramento Ambiental , Resíduos Perigosos/legislação & jurisprudência , Resíduos de Serviços de Saúde/legislação & jurisprudência , Eliminação de Resíduos de Serviços de Saúde/legislação & jurisprudência , Gerenciamento de Resíduos/legislação & jurisprudência
13.
Artigo em Português | Coleciona SUS, CONASS, SES-GO | ID: biblio-1050289

RESUMO

Analisar o papel do enfermeiro no gerenciamento de resíduos de saúde, e na elaboração e implantação do PGRSS. Metodologia: Foi realizado um estudo do tipo revisão bibliográfica. Para levantamento dos artigos foi realizado busca online na Biblioteca Virtual de Saúde (BVS), usando os Descritores de saúde (Decs): Gerenciamento de resíduos; Resíduos hospitalares; Enfermagem. Os critérios de inclusão foram textos em português, disponíveis na íntegra e publicados entre os anos de 2007 e 2015. Os resíduos Hospitalares são produzidos por estabelecimentos de assistências na saúde, instituições de ensino e pesquisa. A composição desse lixo é a mais variada e vem assumindo grande importância. A COFEN nº 303 ampara o enfermeiro a assumir o cargo de Responsável Técnico do PGRSS. Foram encontrados 14 artigos, destes oito foram excluídos por fuga ao tema e incluíram-se seis artigos. Conclui-se que o papel do enfermeiro no gerenciamento de resíduos dos serviços de saúde é planejar e implementar um plano de gerenciamento desses resíduos, a partir de bases científicas e técnicas, normativas e legais.


To analyze the role of nurses in health waste management, and in the design and implementation of the PGRSS. Methodology: A bibliographic review was carried out. To search the articles, an online search was performed at the Virtual Health Library (VHL), using health descriptors (Decs): Waste management; Hospital waste; Nursing. The inclusion criteria were Portuguese texts, available in full and published between the years 2007 and 2015. Hospital waste is produced by health care establishments, educational institutions and research. The composition of this garbage is the most varied and has been assuming great importance. COFEN No. 303 supports the nurse to assume the position of Technical Officer of the PGRSS. A total of 14 articles were found, of which eight were excluded due to flight to the theme and six articles were included. It is concluded that the role of nurses in health services waste management is to plan and implement a waste management plan based on scientific and technical, normative and legal bases.


Assuntos
Humanos , Masculino , Feminino , Eliminação de Resíduos de Serviços de Saúde , Papel do Profissional de Enfermagem , Resíduos de Serviços de Saúde , Gerenciamento de Resíduos
14.
Am J Health Syst Pharm ; 76(Supplement_4): S102-S106, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31621877

RESUMO

PURPOSE: Intravenous immune globulin (IVIG) is a high-cost medication used in a diverse range of settings. At many institutions, IVIG is dosed using total body weight (TBW). Recent evidence suggests that alternative dosing weights reduce waste without compromising clinical outcomes. The objective of this study was to quantify the waste reduction potential generated through the use of alternative IVIG dosing weights. METHODS: We performed a retrospective analysis of all IVIG doses administered from January 2011 through January 2016 to adults (≥18 years). TBW and height at the time of administration were used to calculate prescribed dose (g/kg), ideal body weight (IBW), and adjusted body weight (AdjBW). Three dosing methods were analyzed, as follows: use of AdjBW if TBW is >120% IBW (method 1), AdjBW for all doses (method 2), and IBW for all doses (method 3). Outcomes included potential IVIG use averted, direct drug cost savings, and reductions in outpatient infusion times for each method. RESULTS: A total of 9,918 doses were administered to 2,564 patients over 5 years, representing an average usage of 75,994 g/year. If dosing methods 1, 2, and 3 had been used, the annual use of IVIG would have decreased by 21.9% (16,658 g/year, p < 0.001), 24.2% (18,371 g/year, p < 0.001), and 35.9% (27,252 g/year, p < 0.001), respectively. This translates into average annual cost differences of $2.37 million, $2.62 million, and $3.89 million and average annual outpatient infusion time savings of 841 hours, 920 hours, and 1,366 hours, respectively. CONCLUSION: IVIG dosing optimization through use of alternative dosing weights represents a significant source of waste reduction and cost reduction.


Assuntos
Redução de Custos/métodos , Cálculos da Dosagem de Medicamento , Imunoglobulinas Intravenosas/administração & dosagem , Neoplasias/tratamento farmacológico , Adulto , Idoso , Estatura , Índice de Massa Corporal , Peso Corporal , Institutos de Câncer/economia , Institutos de Câncer/estatística & dados numéricos , Simulação por Computador , Redução de Custos/estatística & dados numéricos , Custos de Medicamentos , Feminino , Humanos , Imunoglobulinas Intravenosas/economia , Imunoglobulinas Intravenosas/farmacocinética , Infusões Intravenosas/economia , Infusões Intravenosas/estatística & dados numéricos , Masculino , Resíduos de Serviços de Saúde/prevenção & controle , Resíduos de Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Econômicos , Neoplasias/economia , Neoplasias/imunologia , Serviço de Farmácia Hospitalar/economia , Serviço de Farmácia Hospitalar/estatística & dados numéricos , Estudos Retrospectivos
15.
A A Pract ; 13(11): 440-441, 2019 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-31609724

RESUMO

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.


Assuntos
Dióxido de Carbono/análise , Eliminação de Resíduos de Serviços de Saúde/economia , Resíduos de Serviços de Saúde/classificação , Anestesiologia , Eliminação de Resíduos de Serviços de Saúde/métodos , Salas Cirúrgicas , Reciclagem , Estados Unidos
16.
Biomedica ; 39(s1): 135-149, 2019 05 01.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31529856

RESUMO

INTRODUCTION: The use of antibiotics in humans, animal husbandry and veterinary activities induces selective pressure leading to the colonization and infection by resistant strains. OBJECTIVE: We evaluated water samples collected from rivers of the Guanabara Bay, which have suffered minor and major environmental degradation, and clinical samples of hospital origin to detect evidence of the presence of resistance genes to aminoglycosides, beta-lactam antibiotics and fluoroquinolones in strains of Klebsiella pneumoniae subsp. pneumoniae, K. pneumoniae subsp. ozaenae and Escherichia coli. MATERIALS AND METHODS: For isolation of the water strains we employed culture media containing 32 µg/ml cephalotin and 8 µg/ml gentamicin. The strains from clinical materials were selected using culture media containing 8 µg/ml gentamicin. The strains were identified and subjected to antimicrobial susceptibility testing (AST), plasmid DNA extraction and polymerase chain reaction (PCR) to detect genes encoding enzymes modifying aminoglycosides (EMA), extended-spectrum beta-lactamases (ESBL) and plasmid mechanisms of quinolone resistance (PMQR). RESULTS: The AST of the isolates recovered from water samples showed multidrugresistance profiles similar to those found in isolates recovered from clinical materials. All isolates from water samples and 90% of the isolates from clinical samples showed at least one plasmid band. In the PCR assays, 7.4% of the isolates recovered from water samples and 20% of those from clinical materials showed amplification products for the three antimicrobial classes. CONCLUSION: We believe that the detection of microorganisms presenting genetic elements in environments such as water is necessary for the prevention and control of their dissemination with potential to infect humans and other animals in eventual contact with these environments.


Assuntos
Baías/microbiologia , Farmacorresistência Bacteriana Múltipla , Infecções por Enterobacteriaceae/microbiologia , Enterobacteriaceae/efeitos dos fármacos , Genes Bacterianos , Rios/microbiologia , Microbiologia da Água , Proteínas de Bactérias/genética , Proteínas de Bactérias/fisiologia , Brasil/epidemiologia , Contagem de Colônia Microbiana , DNA Bacteriano/genética , Farmacorresistência Bacteriana Múltipla/genética , Enterobacteriaceae/enzimologia , Enterobacteriaceae/genética , Enterobacteriaceae/isolamento & purificação , Hospitais Urbanos , Humanos , Resíduos de Serviços de Saúde , Plasmídeos/genética , Poluição da Água
17.
Environ Sci Pollut Res Int ; 26(31): 31812-31821, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31487008

RESUMO

Various types of micropollutants, e.g., pharmaceuticals and their metabolites and resistant strains of pathogenic microorganisms, are usually found in hospital wastewaters. The aim of this paper was to study the presence of 74 frequently used pharmaceuticals, legal and illegal drugs, and antibiotic-resistant bacteria in 5 hospital wastewaters in Slovakia and Czechia and to compare the efficiency of several advanced oxidations processes (AOPs) for sanitation and treatment of such highly polluted wastewaters. The occurrence of micropollutants and antibiotic-resistant bacteria was investigated by in-line SPE-LC-MS/MS technique and cultivation on antibiotic and antibiotic-free selective diagnostic media, respectively. The highest maximum concentrations were found for cotinine (6700 ng/L), bisoprolol (5200 ng/L), metoprolol (2600 ng/L), tramadol (2400 ng/L), sulfamethoxazole (1500 ng/L), and ranitidine (1400 ng/L). In the second part of the study, different advanced oxidation processes, modified Fenton reaction, ferrate(VI), and oxidation by boron-doped diamond electrode were tested in order to eliminate the abovementioned pollutants. Obtained results indicate that the modified Fenton reaction and application of boron-doped diamond electrode were able to eliminate almost the whole spectrum of selected micropollutants with efficiency higher than 90%. All studied methods achieved complete removal of the antibiotic-resistant bacteria present in hospital wastewaters.


Assuntos
Ferro/química , Eliminação de Resíduos Líquidos/métodos , Águas Residuárias/química , Águas Residuárias/microbiologia , Boro , Cromatografia Líquida , República Tcheca , Diamante , Farmacorresistência Bacteriana , Eletrodos , Hospitais , Peróxido de Hidrogênio/química , Drogas Ilícitas/análise , Resíduos de Serviços de Saúde , Oxirredução , Preparações Farmacêuticas/análise , Eslováquia , Espectrometria de Massas em Tandem , Eliminação de Resíduos Líquidos/instrumentação , Águas Residuárias/análise , Poluentes Químicos da Água/análise
18.
Transfus Med ; 29(5): 338-343, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31475416

RESUMO

OBJECTIVE: To evaluate the degree of blood product and technical resources wasted as a result of allergic transfusion reactions. BACKGROUND: Allergic reactions are common, and most are non-severe with rash, urticaria, or pruritus. Management includes treatment of symptoms and completion of transfusion. A quality review demonstrated that 30% of transfusion reaction work-ups at our institution were allergic. This raised the concern of product wastage and unnecessary utilisation of laboratory resources. METHODS: We conducted a retrospective study of allergic reactions, including type of product implicated, volume of products transfused and discarded, the severity of reaction, the use of medications, the incidence of symptom resolution and the rate of repeat transfusion after the allergic event. RESULTS: Of 179 allergic reactions, non-severe reactions were reported in 75%. Non-severe reactions were associated with red blood cell, whereas most severe reactions were associated with platelets. Few cases had premedication; however, 83% of reactions were treated once symptoms developed, and 96% resolved. Of transfusions, 61% were stopped because of symptoms before the transfusion was completed. Of patients with non-severe reactions and transfusions that were not completed, 36% were transfused again within 48 h, representing 16% of all allergic reactions. CONCLUSION: Allergic reactions resulted in partial transfusion of the prescribed product in just over half of the cases reviewed. Most of these reactions were non-severe, resolved with treatment and could have been completed, thus representing wastage of both blood products and the expense of the reaction evaluation. Educational efforts to eliminate/minimise this waste are in development.


Assuntos
Transfusão de Componentes Sanguíneos/efeitos adversos , Hipersensibilidade , Resíduos de Serviços de Saúde , Reação Transfusional , Gerenciamento de Resíduos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Hipersensibilidade/epidemiologia , Hipersensibilidade/etiologia , Lactente , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Reação Transfusional/epidemiologia , Reação Transfusional/etiologia
19.
Orthop Traumatol Surg Res ; 105(6): 1205-1209, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31473131

RESUMO

BACKGROUND: During an orthopedic or trauma surgery procedure, when an implantable medical device is unpackaged, not implanted and cannot be resterilized, it is considered "waste". The cost burden falls on the hospital. The French Social Security Code provides for add-on reimbursement for certain expensive or very specialized devices (supplementary list of costly implants). To allow its restocking without linking it to a patient or reimbursement request, the wasted implant is tracked in a computerized database. The economic impact of these wasted implants is not known in France. This led us to conduct a retrospective study: 1) to determine the percentage and number of wasted implants, 2) to identify elements related to the surgery that impact implant waste. HYPOTHESIS: Various elements of the surgical environment (type of procedure, specialty, surgeon experience, time of year) can independently contribute to the non-implantation of a medical device. METHODS: We carried out a retrospective observational study of data collected prospectively in the database of our teaching hospital in 2016. The primary outcome was the percentage of wasted implants. The secondary outcome was the mean cost of these wasted implants. These parameters were determined for all the implants used in orthopedics and trauma surgery and tracked in this department, then for each variable hypothesized to led to non-implantation. Our analysis was descriptive, then comparative. RESULTS: In our database, 29,073 devices were tracked (€3,761,180), of which 1995 devices were wasted (6.9%). The total cost of the wasted implants was €179,193 (4.8% of the overall cost). The breakdown of the wasted implants was 430 (4.4%) from the add-on list (average cost of €293.10) versus 1565 implants associated with the hospital's diagnosis-related group payment system (average cost of €33.90). Trauma surgery procedures had significantly more wasted implants than orthopedic surgery (1135 vs. 860 (p<0.01)), although the individual cost was less (€59.20 vs. €130.10 (p<0.01)). Fracture fixation implants were more likely to be wasted than ligament reconstruction or arthroplasty implants, with a lower mean cost. More implants were wasted during hip arthroplasty than during other arthroplasty procedures. Less experienced surgeons wasted more implants than more experienced surgeons (1087 vs. 905 (p<0.01)) but these implants cost less (€69.20 vs. €114.80 (p<0.05)). The percentage of implants wasted was higher during the resident changeover period relative to the other months of the year (772 vs. 1223 (p<0.01)). DISCUSSION: This study is the first attempt at quantifying the number and cost of wasted implants in the context of orthopedics and trauma surgery at a teaching hospital in France. While trauma surgery is associated with more wasted implants, the cost burden is higher in orthopedics. Surgeons, by virtue of their experience and teaching mandate, have a decisive role managing this cost burden. TYPE OF STUDY: IV, Retrospective study.


Assuntos
Custos de Cuidados de Saúde , Hospitais Universitários/economia , Resíduos de Serviços de Saúde/economia , Ortopedia/economia , Próteses e Implantes/economia , Centros de Traumatologia/economia , Custos e Análise de Custo , França , Humanos , Estudos Retrospectivos
20.
Environ Int ; 132: 105073, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31421384

RESUMO

Many studies have been conducted on hospital solid waste management (HSWM) throughout the world, especially developing countries. This interdisciplinary study aims to summarize the available knowledge on the health and environmental risks of hospital solid waste (HSW) and also, develop a dynamic associational assessment among hospital solid waste generation rate (HSWGR), hospital solid waste composition (HSWC), gross domestic product (GDP) per capita, and environmental performance index (EPI) in some developing countries for the first time. The results of this study showed that researchers from India, China, Pakistan, Brazil, and Iran had found more evidence about the health, economic, and environmental issues in HSW than the other developing countries. The literature showed that the highest and lowest reported HSWGR (in national average level) belonged to Ethiopia (6.03) and India (0.24) kg bed -1 day-1, respectively. It has also been shown that all studied countries except Serbia, have higher levels of hazardous waste in their HSWC, based on the WHO's standard. Furthermore, the quantity and quality of HSW in developing countries depend on the service provided by the hospital, type of hospital, HSWM system, and the level of regional economic and culture. The association analysis showed that the EPI and GDP per capita of developing countries were significantly (p-value <0.05) associated with HSWGR, non-hazardous HSW, and hazardous HSW by the Spearman coefficients equal to 0.389, 0.118, -0.118, and 0.122, 0.216, and -0.346, respectively. However, it can be concluded that GDP per capita and EPI have a weak correlation with hazardous HSW and non-hazardous HSW. Moreover, HSW has many hazardous health and environmental risks such as dioxin and furan, that must be controlled and managed through implementing programs and policies based on sustainable development. As a final point, we believed that the present study can be considered to be a guide for future studies on HSWM in developing countries.


Assuntos
Países em Desenvolvimento/estatística & dados numéricos , Resíduos Perigosos/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Resíduos Sólidos/estatística & dados numéricos , Gerenciamento de Resíduos/métodos , Brasil , China , Poluição Ambiental , Humanos , Índia , Resíduos de Serviços de Saúde , Paquistão
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