New multi-source waste co-incineration and clustering park operating model for small- and medium-sized city: A case study in China.

With improvements in urban waste management to promote sustainable development, an increasing number of waste types need to be sorted and treated separately. Due to the relatively low amount of waste generated in small- and medium-sized cities, separate treatment facilities for each waste type lack scale, waste is treated at a high cost and low efficiency. Therefore, industrial symbiosis principles are suggested to be used to guide collaborative waste treatment system of multi-source solid wastes, and co-incineration is the most commonly used technology. Most existing studies have focused on co-incineration of one certain waste type (such as sludge or medical waste) with municipal solid waste (MSW), but the systematic design and the comprehensive benefits on a whole city and park level have not been widely studied. Taking the actual operation of a multi-source waste co-incineration park in south-central China as an example, this study conducted a detailed analysis of the waste-energy-water metabolism process of MSW, sludge, food waste, and medical waste co-incineration. The environmental and economic benefits were evaluated and compared with the single decentralized waste treatment mode. The results showed that the multi-source waste co-incineration and clustering park operating model was comprehensively superior to the single treatment mode, greenhouse gases and human toxicity indicators were decreased by 11.87% and 295.74%, respectively, and the internal rate of return of the project was increased by 29.35%. This mainly benefits from the synergy of technical system and the economies of scale. Finally, this research proposed policy suggestions from systematic planning and design, technical route selection, and an innovative management mode in view of the potential challenges.

A review of the applicability of Environmental Management Systems in waste management in the medical sector of Zimbabwe.

Environmental Management Systems (EMS) are currently the cornerstone of achieving sustainability globally. Nevertheless, the question is applicability of EMS in the medical sector. Hence, the review focused on applicability of EMS in medical waste management Zimbabwe. EMS involves overall processes that facilitate reduction of dire impacts of company's activities while increasing performance. EMS framework consists of environmental policy, planning, implementation, checking, review and improvement stages. To examine applicability of EMS in management of medical sector waste, published secondary sources with information related to the topic were utilised. Analysis of strengths and opportunities of EMS was used as a base to examine its applicability in medical waste management. Zimbabwean medical sector consist of hospitals and primary healthcare facilities. Medical waste includes pathological, pharmaceutical, cytotoxic, radioactive, chemical, sharp, infectious and general waste. However, twenty-first century witnessed expansion of medical institutions to accommodate COVID-19 patients, resulting in generation of construction and demotion waste. Medical institutions in Zimbabwe are accountable for solid waste management at generation source although municipalities are responsible for conveying solid waste to landfills. Solid waste from medical sector is disposed through traditional strategies namely landfilling, incineration, open pits and open burning, resulting in water, air, and soil contamination. However, EMS can reduce quantity of solid waste disposed through waste reuse, recycle and recovery. Moreover, achievement of integrated approach, effective legislation, policies and inclusive participation in medical waste management is adopted through use of EMS. Therefore, EMS were utilised to develop an integrated sustainable medical waste management model to achieve sustainability.

A Comparative Analysis of Hazardous Medical Waste Management Compliance Before (2019) and During (2020) the COVID-19 Pandemic in Indonesia.

Background: As a producer of hazardous waste, hospitals have the responsibility to manage the waste they produce. Hospital non-compliance in managing hazardous waste can have a negative impact on the environment and public health, especially during the COVID-19 pandemic, when the amount of hazardous waste produced by healthcare facilities is increasing. To protect the environment and public health from the negative impact of hazardous medical waste, this study was conducted to determine the level of compliance of hazardous waste management in hospitals in Indonesia before and during the COVID-19 pandemic, from 2019 to 2020. Study design: Cross-sectional. Methods: This study was conducted at 343 hospitals in Indonesia using secondary data obtained from Sikelim (Medical Waste Management Information System), which is owned and operated by the Ministry of Health. The data have been analyzed using chi-square tests and logistic regressions of the determinant model. Results: There was an increase in the level of compliance of hazardous waste management in hospitals from 82% to 86% during the pandemic. Furthermore, the availability of environmental documents and environmental health units were determinant factors of hazardous waste management compliance by hospitals before the pandemic in 2019. The only factor in 2020 was the availability of environmental health units. Conclusions: Despite the good level of compliance, additional efforts are needed to increase the activities of the treatment of hazardous medical waste by hospitals, as before the pandemic (i.e., in a normal situation) only 8% of hospitals was able to independently manage hazardous medical waste using authorized incinerators, a percentage that was reduced to 6% during the pandemic.

Electrochemical Technologies to Decrease the Chemical Risk of Hospital Wastewater and Urine.

The inefficiency of conventional biological processes to remove pharmaceutical compounds (PhCs) in wastewater is leading to their accumulation in aquatic environments. These compounds are characterized by high toxicity, high antibiotic activity and low biodegradability, and their presence is causing serious environmental risks. Because much of the PhCs consumed by humans are excreted in the urine, hospital effluents have been considered one of the main routes of entry of PhCs into the environment. In this work, a critical review of the technologies employed for the removal of PhCs in hospital wastewater was carried out. This review provides an overview of the current state of the developed technologies for decreasing the chemical risks associated with the presence of PhCs in hospital wastewater or urine in the last years, including conventional treatments (filtration, adsorption, or biological processes), advanced oxidation processes (AOPs) and electrochemical advanced oxidation processes (EAOPs).

Analysis of quality and quantity of health-care wastes in clinical laboratories: a case study of Ilam city.

Generation of health-care wastes is one of the major concerns in health-care institutions worldwide due to direct and indirect impact on human health and environment. The purpose of the present work was to estimate the quantity and quality of clinical laboratory wastes in the city of Ilam, Iran. In this cross-sectional study, randomly eight clinical laboratories including five in private sector and three governmental clinical laboratories were selected for sampling according to the purpose of the study. The results showed that the total amount of waste generation was 27,700.90 kg/year. The average amount of health-care wastes generation in Ilam city was 0.2 kg/person/year. The portions of general, pathologic, sharp, infectious, and pharmaceutical and chemical wastes were 37, 5, 2, and 56% (by weight), respectively. As a considerable amount of waste is generated in clinical laboratories of Ilam city, therefore, it is necessary to implement integrated plans for the proper management of these wastes. Thus, sufficient training and education programs must be developed for all clinical staffs and that the existing training and education procedures should also be promoted.

Investigating Groundwater Contamination Following the Disposal of Hospital Wastes in a Government Reserved Area, Enugu, Nigeria.

This study investigated the probable contamination of groundwater following hospital wastes disposal in a Government Reserved Area, Enugu, Nigeria. The ground water samples were collected from three distinct locations denoted as GW1, GW2 and GW3 at distances of about 100, 200 and 350 m respectively from the hospital location. The samples were collected during the dry season (December 2015, January and February 2016) and wet season (June, July and August 2016) and analyzed with standard procedures. The level of contamination of groundwater in the area was generally higher in the wet season than in dry season. The degree of contamination varies with distance and hence in the following order GW1 > GW2 > GW3 in both seasons. The study revealed the presence of both pathogenic and non-pathogenic organisms and values of the determined physicochemical ranged from (0.02 ± 0.01-272 ± 2.22 mg/L) in both seasons. The hospital management should develop effective ways to manage their wastes to protect the environment and public health.

Healthcare waste management during disasters and its effects on climate change: Lessons from 2010 earthquake and cholera tragedies in Haiti.

Despite growing effects of human activities on climate change throughout the world, and global South in particular, scientists are yet to understand how poor healthcare waste management practices in an emergency influences the climate change. This article presents new findings on climate change risks of healthcare waste disposal during and after the 2010 earthquake and cholera disasters in Haiti. The researchers analysed quantities of healthcare waste incinerated by the United Nations Mission in Haiti for 60 months (2009 to 2013). The aim was to determine the relationship between healthcare waste incinerated weights and the time of occurrence of the two disasters, and associated climate change effects, if any. Pearson product-moment correlation coefficient indicated a weak correlation between the quantities of healthcare waste disposed of and the time of occurrence of the actual emergencies (r (58) = 0.406, p = 0.001). Correspondingly, linear regression analysis indicated a relatively linear data trend (R2 = 0.16, F (1, 58) = 11.42, P = 0.001) with fluctuating scenarios that depicted a sharp rise in 2012, and time series model showed monthly and yearly variations within 60 months. Given that the peak healthcare waste incineration occurred 2 years after the 2010 disasters, points at the need to minimise wastage on pharmaceuticals by improving logistics management. The Government of Haiti had no data on healthcare waste disposal and practised smoky open burning, thus a need for capacity building on green healthcare waste management technologies for effective climate change mitigation.

[Release of antibiotics into urban wastewater: A secondary-data based analysis for the input assessment using the city of Dresden as an example]. / Antibiotikaeintrag in das urbane Abwasser : Eine sekundärdatenbasierte Analyse zur Eintragsabschätzung am Beispiel der Stadt Dresden.

Antibiotics are essential for the successful treatment of bacterial infections. Recently, the increasing number of resistant bacteria and the occurrence of residues of antibiotics in the environment has become the focus of scientific interest. The aim of the cooperative project ANTI-Resist was to investigate the release of antibiotics and the occurrence and distribution of antibiotic resistance in the urban waste water system of the city of Dresden.This article presents the main results of the secondary data analysis for the determination of outpatient and inpatient antibiotic consumption and provides an insight into the complexity of the topic antibiotics in waste water.Based on the data of outpatient prescriptions provided by the AOK PLUS for the period 2005 to 2013, thirteen focus substances were identified to estimate antibiotic consumption. Furthermore, delivery data from the pharmacies of three hospitals in Dresden were available.Depending on the substances investigated, seasonality and age dependency were determined. The results at a regional level were mostly in good accordance with general trends throughout Germany. It should be noted that the total amount of antibiotics used remained nearly constant over the whole period investigated, but the prescription of fluoroquinolones increased. This must be questioned when taking into account the increasingly critical situation in the treatment of Gram-negative bacteria in particular. Examinations of waste water conducted indicated that sewage treatment plants are not able to remove antibiotics or their metabolites completely from waste water. The residues are released into surface waters via the treatment plants. The impact cannot be assessed at the moment and further investigations are necessary.

Management of wastes from hospitals: A case study in Pakistan.

Proper management of hospital waste is a critical concern in many countries of the world. Pakistan is the sixth most populous country in the world, with one of the highest urbanisation and population growth rates in South Asia. Data and analyses regarding hospital waste management practices in Pakistan are scarce in scientific literature. This study was meant to determine waste management practices at selected hospitals in a major city in Pakistan, Gujranwala. A total of 12 different hospitals were selected for the survey, which involved quantification of waste generation rates and investigation of waste management practices. The results were analysed using linear regression. The weighted average total, general and infectious hospital waste generation rates were found to be 0.667, 0.497 and 0.17 kg bed-day(-1), respectively. Of the total, 73.85% consisted of general, 25.8% consisted of hazardous infectious and 0.87% consisted of sharps waste. The general waste consisted of 15.76% paper, 13.41% plastic, 21.77% textiles, 6.47% glass, 1.99% rubber, 0.44% metal and 40.17% others. Linear regression showed that waste generation increased with occupancy and decreased with number of beds. Small, private and specialised hospitals had relatively greater waste generation rates. Poor waste segregation, storage and transportation practices were observed at all surveyed hospitals.

Developing models for the prediction of hospital healthcare waste generation rate.

An increase in the number of health institutions, along with frequent use of disposable medical products, has contributed to the increase of healthcare waste generation rate. For proper handling of healthcare waste, it is crucial to predict the amount of waste generation beforehand. Predictive models can help to optimise healthcare waste management systems, set guidelines and evaluate the prevailing strategies for healthcare waste handling and disposal. However, there is no mathematical model developed for Ethiopian hospitals to predict healthcare waste generation rate. Therefore, the objective of this research was to develop models for the prediction of a healthcare waste generation rate. A longitudinal study design was used to generate long-term data on solid healthcare waste composition, generation rate and develop predictive models. The results revealed that the healthcare waste generation rate has a strong linear correlation with the number of inpatients (R(2) = 0.965), and a weak one with the number of outpatients (R(2) = 0.424). Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching and private). In these models, the number of inpatients and outpatients were revealed to be significant factors on the quantity of waste generated. The influence of the number of inpatients and outpatients treated varies at different hospitals. Therefore, different models were developed based on the types of hospitals.

Implementation of a multi-variable regression analysis in the assessment of the generation rate and composition of hospital solid waste for the design of a sustainable management system in developing countries.

Forecasting of hospital solid waste generation is a critical challenge for future planning. The composition and generation rate of hospital solid waste in hospital units was the field where the proposed methodology of the present article was applied in order to validate the results and secure the outcomes of the management plan in national hospitals. A set of three multiple-variable regression models has been derived for estimating the daily total hospital waste, general hospital waste, and total hazardous waste as a function of number of inpatients, number of total patients, and number of beds. The application of several key indicators and validation procedures indicates the high significance and reliability of the developed models in predicting the hospital solid waste of any hospital. Methodology data were drawn from existent scientific literature. Also, useful raw data were retrieved from international organisations and the investigated hospitals' personnel. The primal generation outcomes are compared with other local hospitals and also with hospitals from other countries. The main outcome, which is the developed model results, are presented and analysed thoroughly. The goal is this model to act as leverage in the discussions among governmental authorities on the implementation of a national plan for safe hospital waste management in Palestine.

Forecasting medical waste generation using short and extra short datasets: Case study of Lithuania.

The aim of the study is to evaluate the performance of various mathematical modelling methods, while forecasting medical waste generation using Lithuania's annual medical waste data. Only recently has a hazardous waste collection system that includes medical waste been created and therefore the study access to gain large sets of relevant data for its research has been somewhat limited. According to data that was managed to be obtained, it was decided to develop three short and extra short datasets with 20, 10 and 6 observations. Spearman's correlation calculation showed that the influence of independent variables, such as visits at hospitals and other medical institutions, number of children in the region, number of beds in hospital and other medical institutions, average life expectancy and doctor's visits in that region are the most consistent and common in all three datasets. Tests on the performance of artificial neural networks, multiple linear regression, partial least squares, support vector machines and four non-parametric regression methods were conducted on the collected datasets. The best and most promising results were demonstrated by generalised additive (R(2) = 0.90455) in the regional data case, smoothing splines models (R(2) = 0.98584) in the long annual data case and multilayer feedforward artificial neural networks in the short annual data case (R(2) = 0.61103).

Oxidative treatment of fentanyl compounds in water by sodium bromate combined with sodium sulphite.

As narcotic analgesics, fentanyl compounds have been commonly produced and widely used during surgical procedures. The residual and waste of fentanyl compounds have potential harmful impacts on the environment and human health. The oxidative degradation of fentanyl compounds by sodium bromate mixed systems was studied. Factors influencing the oxidation reaction, including molar ratio of NaBrO3/H(+)/SO3(2-), molar ratio of NaBrO3/fentanyl and pH, were investigated. Fentanyl, carfentanil and 3-methylfentanyl were able to be completely degraded in 30 minutes by a NaBrO3 mixed system under optimum conditions, the molar ratio of NaBrO3/H(+)/SO3(2-) equal to 20:3:10, the molar ratio of NaBrO3:fentanyl compounds 50:1 and pH = 4. Sufentanil was only able to be degraded by 74% under the same conditions. The degradation products of the fentanyl compounds detected and identified by gas chromatography/mass spectrometry suggested several possible degradation pathways.

Dioxins from medical waste incineration: Normal operation and transient conditions.

Polychlorinated dibenzo-p-dioxins (PCDDs) and polychlorinated dibenzofurans (PCDFs) are key pollutants in waste incineration. At present, incinerator managers and official supervisors focus only on emissions evolving during steady-state operation. Yet, these emissions may considerably be raised during periods of poor combustion, plant shutdown, and especially when starting-up from cold. Until now there were no data on transient emissions from medical (or hospital) waste incineration (MWI). However, MWI is reputed to engender higher emissions than those from municipal solid waste incineration (MSWI). The emission levels in this study recorded for shutdown and start-up, however, were significantly higher: 483 ± 184 ng Nm(-3) (1.47 ± 0.17 ng I-TEQ Nm(-3)) for shutdown and 735 ng Nm(-3) (7.73 ng I-TEQ Nm(-3)) for start-up conditions, respectively. Thus, the average (I-TEQ) concentration during shutdown is 2.6 (3.8) times higher than the average concentration during normal operation, and the average (I-TEQ) concentration during start-up is 4.0 (almost 20) times higher. So monitoring should cover the entire incineration cycle, including start-up, operation and shutdown, rather than optimised operation only. This suggestion is important for medical waste incinerators, as these facilities frequently start up and shut down, because of their small size, or of lacking waste supply. Forthcoming operation should shift towards much longer operating cycles, i.e., a single weekly start-up and shutdown.

Sustainability and shared smart and mutual--green growth (SSaM-GG) in Korean medical waste management.

Since medical insurance was introduced in the Republic of Korea, there have been several increases concerning medical waste. In order to solve these problems, we have applied life cycle assessment and life cycle cost. But these methods cannot be a perfect decision-making tool because they can only evaluate environmental and economic burdens. Thus, as one of many practical methods the shared smart and mutual - green growth considers economic growth, environmental protection, social justice, science technology and art, and mutual voluntarism when applied to medical waste management in the Republic of Korea. Four systems were considered: incineration, incineration with heat recovery, steam sterilisation, and microwave disinfection. This research study aimed to assess pollutant emissions from treatment, transport, and disposal. Global warming potential, photochemical oxidant creation potential, acidifications potential, and human toxicity are considered to be environmental impacts. Total investment cost, transport cost, operation, and maintenance cost for the medical waste are considered in the economy evaluations though life cycle cost. The social development, science technology and art, and mutual voluntarism are analysed through the Delphi-method conducted by expert groups related to medical waste. The result is that incineration with heat recovery is the best solution. However, when heat recovery is impossible, incineration without heat recovery becomes the next best choice. That is why 95% of medical waste is currently treated by both incineration and incineration with heat recovery within the Republic of Korea.

[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.

Occurrence of cytostatic compounds in hospital effluents and wastewaters, determined by liquid chromatography coupled to high-resolution mass spectrometry.

The occurrence of 26 commonly used cytostatic compounds in wastewaters was evaluated using an automated solid-phase extraction (SPE) method with liquid chromatography-high-resolution mass spectrometry (LC-HRMS). Detection was optimized using Oasis HLB SPE cartridges at pH 2. Two hospital effluents and their two receiving wastewater treatment plants were sampled over five days. In hospital effluents, eight cytostatics were detected at levels up to 86.2 µg L(-1) for ifosfamide, 4.72 µg L(-1) for cyclophosphamide, and 0.73 µg L(-1) for irinotecan, the three most relevant compounds identified. Cyclophosphamide and megestrol acetate were found in wastewaters at concentrations up to 0.22 µg L(-1) for the latter. The predicted environmental concentrations (PEC) in sewage effluents of ifosfamide (2.4-4.3 ng L(-1)), capecitabine (11.5-14.2 ng L(-1)), and irinotecan (0.4-0.6 ng L(-1)), calculated from consumption data in each hospital, published excretion values for the target compounds, and wastewater elimination rates, were in agreement with experimental values.

Iodine-131 monitoring in sewage plant outflow.

Three different hospital sites (Oxford, Sutton and Guildford) have performed sampling of their local sewage plant outflow to determine levels of radioactivity resulting from iodine-131 patients undergoing radionuclide therapies. It was found that a maximum of 20% of activity discharged from the hospitals was present in the sewage plant final effluent channel. This is significantly below the level predicted by mathematical models in current use. The results further show that abatement systems to reduce public exposure are unlikely to be warranted at hospital sites.

Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia.

In many developing countries, the inadequacy of data regarding the quantity and composition of healthcare waste is one of the major reasons for improper healthcare waste management. We investigated the generation rate and composition of healthcare wastes in six public and three private hospitals. We conducted healthcare waste composition and characterization measurements for seven consecutive days in the selected hospitals following the protocol described by the World Health Organization (WHO). The results revealed that the total generation rate of healthcare wastes of hospitals ranged from 0.25 to 2.77 kg/bed/day with a median value of 1.67 kg/bed/day for inpatients to 0.21-0.65 in kg/patient/day with a median value of 0.31 kg/patient/day for outpatients. The waste generation rate in private hospitals (median 3.9 kg/bed/day) was significantly greater (Kruskal-Wallis test, P < 0.05) than in government hospitals (median 1.5 kg/bed/day). The median values of percent hazardous waste estimated for private and government hospitals were 63.4% and 52.2%, respectively. These figures are about three times greater than the threshold values recommended by the WHO. This situation might be attributed to the improper practice of healthcare waste segregation by health professionals and auxiliary health workers due to inadequate risk perception and lack of enforced public health regulations. The study revealed that the generation rate and proportion of hazardous waste significantly varies between public and private hospitals and number of patients treated per day.

Experimental and modeling study of medical waste based on plasma gasification.

Plasma gasification melting (PGM) provides reliable disposal of toxic medical waste with a low heating value, which is capable of converting waste into energy. This study investigates the performance of experiments on plasma gasification for the treatment of chemical-pharmaceutical medical waste (CPMW) with an air medium. A comparative analysis is performed for gasification characteristics at three reactor temperatures (1000, 1400, and 1800 °C). Moreover, a thermodynamic equilibrium model is developed to assess performance features such as syngas yield, high heating value, and cold gas efficiency in the gasification temperature range of 1000-1800 °C. A comparison of the experiment and computational outcomes shows a good agreement. The results show that the quality of syngas and heating value is improved by increasing the temperature of the plasma gasifier so that at 1800 °C, H2, CO, and higher heating value (HHV) are obtained as 41 %, 37 %, and 10 MJ/Nm3, respectively. The obtained syngas is a clean fuel with low sulfur-containing and nitrogen-containing. The experimental results provide an extensive comprehension of CPMW gasification in a plasma reactor and consider a possibility for hydrogen and energy production.