Health risks of solid waste management practices in rural Ghana: A semi-quantitative approach toward a solid waste safety plan.

Inadequate solid waste management (SWM) can lead to environmental contamination and human health risks. The health risks from poor SWM can vary based on specific practices and exposure pathways. Thus, it is necessary to adequately understand the local context. This information, however, is rarely available in low-resource settings, particularly in rural areas. A solid waste safety plan could be helpful in these settings for gathering necessary data to assess and minimize health risks. As a step in developing such a tool, a semi-quantitative health risk analysis of SWM practices in nine Ghanaian rural villages was undertaken. Data on SWM in each village were collected through qualitative field observations and semi-structured interviews with local stakeholders. SWM-related health risks were assessed using the collected data, similar case studies in the scientific literature and dialogue among an assembled team of experts. The analysis identified context-specific practices and exposure pathways that may present the most substantial health risks as well as targeted solutions for mitigation risks. A risk assessment matrix was developed to quantify SWM risks as low, medium, high, or very high based on the likelihood and severity of identified hazards. The highest SWM risks were identified from dumpsites and uncontrolled burying of solid waste. More specifically, a very high or high risk of infectious and vector-borne diseases from SWM in the villages was identified, both in the disposal of solid waste in dumpsites and uncontrolled burying of solid waste. Additionally, a very high or high risk of inhalation, ingestion or dermal contact with contaminants was found in the disposal of solid waste in dumpsites, open burning of waste and reuse of waste from dumpsites as compost. The results demonstrate the potential value of a solid waste safety plan and a parsimonious approach to collect key local data to inform its contents.

An evaluation of the management of offensive waste from the National Health Service in England: A case study approach.

In the UK, the majority of offensive waste is disposed of at landfills. However, producers have a duty of care under the Waste Hierarchy to divert waste away from landfill. Using case studies from the East of England, the East Midlands and West Midlands in England, this study sought to quantify the waste arisings disposed of to landfill and to understand the reasons why. The findings show that offensive waste arisings, treatment method and costs varied by region, only a fraction of the waste disposed of to landfill in the East of England, compared with the majority being disposed of to landfill in the East Midlands and West Midlands. Despite the financial implications of landfilling being the lowest cost per tonne option, the key barriers to moving away from disposal to landfill was a lack of available alternatives, and it being the only option offered by the waste contractor.

Overcoming public health risks to staff during the management of waste from healthcare facilities.

Purpose The management of public health risks is a key focus for the European Union. One of the key factors that has been shown to pose a public health risk is that of the management of needles from healthcare facilities. The paper aims to discuss this issue. Design/methodology/approach Using audits of two case study hospitals based in northern Italy, this study sought to examine the key factors that resulted in needle stick injuries amongst staff and suggest measures to minimise these risks. Findings The number of needle stick injuries was influenced by various key factors including the time period during the year, the length of time employed, the location within the site, staff category and working hours. Practical implications Suggestions for overcoming the risk factors, including redesigning working patterns, staff training and awareness building, and the use of safety-engineered devices are outlined. Originality/value This study examined the incidence of needle stick injuries amongst healthcare staff in two Italian hospitals, which was lower than in other countries due to various factors, including recapping of needles not being allowed, the introduction of self-retractable needles and awareness campaigns about the correct disposal procedures of potentially infectious waste.

Costs associated with the management of waste from healthcare facilities: An analysis at national and site level.

Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day-1 bed-1), paediatric and intensive care (3.37 kg day-1 bed-1) and gastroenterology-digestive endoscopy (3.09 kg day-1 bed-1). Annual overall waste management costs were $US5,079,191, or approximately $US2.36 kg-1, with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation.

Environmental audits and process flow mapping to assess management of solid waste and wastewater from a healthcare facility: an Italian case study.

In Europe, there are an increasing number of policy and legislative drivers for a more sustainable approach to the management of natural resources as well as for the mitigation of environmental health risks. However, despite significant progress in recent years, there is still some way to go to achieve circularity of process, as well as risk mitigation within organisations. Using a case study of the Gardone Val Trompia hospital in northern Italy, this manuscript offers a novel holistic examination of strategies to enhance resource efficiency and environmental health within a key sector, i.e. the healthcare sector. Through the use of environmental audits and process flow mapping, trends in waste and wastewater arisings and the associated financial and environmental costs and risks were identified. Recommendations for developing more resource efficient approaches as well as mitigating the environmental and public health risks are suggested. These include strategies for improved resource efficiency (including reduction in the hazardous waste) and reduced environmental impacts during the containment, transport and treatment of the waste.

Enhancing engagement with community sector organisations working in sustainable waste management: A case study.

Voluntary and community sector organisations are increasingly being viewed as key agents of change in the shifts towards the concepts of resource efficiency and circular economy, at the community level. Using a meta-analysis and questionnaire surveys across three towns in the East Midlands of England, namely Northampton, Milton Keynes and Luton, this study aimed to understand public engagement with these organisations. The findings suggest that these organisations play a significant and wide-spread role, not only with regard to sustainable environmental management, but also a social role in community development and regeneration. The surveys indicated that there were generally high levels of awareness of the organisations and strong engagement with them. Clothes were the items most donated. Key reasons for engagement included the financial value offered and the perception that it helped the environment. However, potential limitations in future public engagement were also determined and recommendations for addressing these suggested.

Strategies to enhance waste minimization and energy conservation within organizations: a case study from the UK construction sector.

Strategies for enhancing environmental management are a key focus for the government in the UK. Using a manufacturing company from the construction sector as a case study, this paper evaluates selected interventionist techniques, including environmental teams, awareness raising and staff training to improve environmental performance. The study employed a range of methods including questionnaire surveys and audits of energy consumption and generation of waste to examine the outcomes of the selected techniques. The results suggest that initially environmental management was not a focus for either the employees or the company. However, as a result of employing the techniques, the company was able to reduce energy consumption, increase recycling rates and achieve costs savings in excess of £132,000.

Municipal Solid Waste Management and Adverse Health Outcomes: A Systematic Review.

Municipal solid waste (MSW) can pose a threat to public health if it is not safely managed. Despite prior research, uncertainties remain and refurbished evidence is needed along with new approaches. We conducted a systematic review of recently published literature to update and expand the epidemiological evidence on the association between MSW management practices and resident populations' health risks. Studies published from January 2005 to January 2020 were searched and reviewed following PRISMA guidelines. Eligible MSW treatment or disposal sites were defined as landfills, dumpsites, incinerators, waste open burning, transfer stations, recycling sites, composting plants, and anaerobic digesters. Occupational risks were not assessed. Health effects investigated included mortality, adverse birth and neonatal outcomes, cancer, respiratory conditions, gastroenteritis, vector-borne diseases, mental health conditions, and cardiovascular diseases. Studies reporting on human biomonitoring for exposure were eligible as well. Twenty-nine studies were identified that met the inclusion criteria of our protocol, assessing health effects only associated with proximity to landfills, incinerators, and dumpsites/open burning sites. There was some evidence of an increased risk of adverse birth and neonatal outcomes for residents near each type of MSW site. There was also some evidence of an increased risk of mortality, respiratory diseases, and negative mental health effects associated with residing near landfills. Additionally, there was some evidence of increased risk of mortality associated with residing near incinerators. However, in many cases, the evidence was inadequate to establish a strong relationship between a specific exposure and outcomes, and the studies rarely assessed new generation technologies. Evidence gaps remain, and recommendations for future research are discussed.

Utilizing an integrated assessment scheme for sustainable waste management in low and middle-income countries: Case studies from Bosnia-Herzegovina and Mozambique.

Solid waste management assessment methods that simultaneously analyze the economic, social and environmental dimensions are limited. Tools are rarely applied in developing countries because of several constraints encountered during their implementation (e.g. lack of data availability and difficulties concerning data interpretation), consequently hampering the development of sustainable solid waste management practices. In addition, the incorporation of stakeholders in most decision-making tools and processes, as well as the availability of credible data in developing countries is often limited. To address these issues, this paper presents one of the first large scale studies, utilizing a tool, named Integrated Assessment Scheme (IAS). Use of IAS provides a holistic, integrated approach evaluating the economic, environmental and social dimensions in order to support the decision making process and to facilitate more sustainable waste management in low and middle-income countries. The use of IAS in the two case studies from Bosnia-Herzegovina and Mozambique suggests its suitability to communities in similar contexts. However, its limitations are also discussed.

An Evaluation of Staff Engagement with Infectious Healthcare Waste Management Policies: A Case Study of Tunisia.

This study evaluated the engagement of staff regarding infectious healthcare waste management, in two case-study universities in Tunisia. Using a questionnaire survey, it was found that the most significant reported factors that influenced engagement were the availability of technical sheets and posters, training and education programs, and the age range of the staff. While there was some accordance with the Tunisian Decree application n° 2008-2745 of July 28th, 2008, as well as international guidelines and best practice (e.g. the use of color coded bins, waste management teams, and infection control measures), there were also limitations in the provision of training. This limitation in training and, to a lesser extent, awareness impacted on the beliefs about infectious healthcare waste management of staff and their practices. Recommendations for addressing these issues are suggested.

Characteristics of leachate from landfills and dumpsites in Asia, Africa and Latin America: an overview.

Using published data, this study examined differences in pollutant levels in the leachate between landfills and dumpsites in Africa, Asia and Latin America. It is the first to focus on the impacts of climate and the age of the site on the pollutants in these continents, from a holistic perspective. Differences between geographical regions were limited. While it was found that there were statistically significant differences in organic, inorganic loads and heavy metals between landfills and dumpsites, with higher concentration of pollutants in dumpsites. Links between selected metals were found, in particular for Cu, Cr, Zn, Pb and Mn. Contrary to the findings of others, climate and the age of the site generally did not have statistically significant impacts on pollutant levels. This suggests that the concentration of pollutants from sites in the three continents may be more influenced by local conditions, consumption patterns and the waste management habits of individuals. Implications for governance are discussed.

Assessment of health-care waste management in a humanitarian crisis: A case study of the Gaza Strip.

Health-care waste management requires technical, financial and human resources, and it is a challenge for low- and middle income countries, while it is often neglected in protracted crisis or emergency situations. Indeed, when health, safety, security or wellbeing of a community is threatened, solid waste management usually receives limited attention. Using the Gaza Strip as the case study region, this manuscript reports on health-care waste management within the context of a humanitarian crisis. The study employed a range of methods including content analyses of policies and legislation, audits of waste arisings, field visits, stakeholder interviews and evaluation of treatment systems. The study estimated a production from clinics and hospitals of 683kg/day of hazardous waste in the Gaza Strip, while the total health-care waste production was 3357 kg/day. A number of challenges was identified including lack of clear definitions and regulations, limited accurate data on which to base decisions and strategies and poor coordination amongst key stakeholders. Hazardous and non-hazardous waste was partially segregated and treatment facilities hardly used, and 75% of the hazardous waste was left untreated. Recommendations for mitigating these challenges posed to patients, staff and the community in general are suggested. The outputs are particularly useful to support decision makers, and re-organize the system according to reliable data and sound assumptions. The methodology can be replicated in other humanitarian settings, also to other waste flows, and other sectors of environmental sanitation.

Factors driving the development of healthcare waste management in the United Kingdom over the past 60 years.

Since the creation of the National Health Service (NHS) in the United Kingdom in 1948 there have been significant changes in the way waste materials produced by healthcare facilities have been managed due to a number of environmental, legal and social drivers. This paper reviews the key changes in legislation and healthcare waste management that have occurred in the UK between 1948 and the present time. It investigates reasons for the changes and how the problems associated with healthcare wastes have been addressed. The reaction of the public to offensive disposal practices taking place locally required political action by the UK government and subsequently by the European legislature. The relatively new UK industry of hazardous healthcare waste management has developed rapidly over the past 25 years in response to significant changes in healthcare practices. The growth in knowledge and appreciation of environmental issues has also been fundamental to the development of this industry. Legislation emanating from Europe is now responsible for driving change to UK healthcare waste management. This paper examines the drivers that have caused the healthcare waste management to move forward in the 60 years since the NHS was formed. It demonstrates that the situation has moved from a position where there was no overall strategy to the current situation where there is a strong regulatory framework but still no national strategy. The reasons for this situation are examined and based upon the experience gained; suggestions are made for the benefit of countries with systems for healthcare waste management still in the early stages of development or without any provisions at all.

An overview of arisings and large-scale treatment technologies for healthcare waste in the United Kingdom.

This paper reviews the current generation and management of healthcare waste in the United Kingdom, with a focus on that produced from healthcare provision in the National Health Service. While the current capacities of large-scale off-site treatment systems are adequate, there are a number of logistical factors that must be considered in future. These include variations in arisings from each country and from various regions within each country, the age and location of treatment/disposal facilities, the quantities, types and sources of healthcare waste, and the impact of waste minimization and recycling strategies. Managing UK healthcare waste is a complex issue that requires the correct technologies and capacities to be available. With increasing quantities and costs there is urgent need for future planning, and healthcare waste issues need to be addressed from a UK-wide perspective. Holistic strategies need to incorporate both minimization and segregation, with treatment using a combination of incineration and alternatives treatment technologies. The need for more research and accurate data to provide an evidence-base for future decision-making is highlighted.

Utilizing a 'systems' approach to improve the management of waste from healthcare facilities: best practice case studies from England and Wales.

Changes in environmental legislation and standards governing healthcare waste, such as the Hazardous Waste Regulations are expected to have a significant impact on healthcare waste quantities and costs in England and Wales. This paper presents findings from two award winning case study organizations, the Cardiff and Vale NHS Trust and the Cornwall NHS Trust on 'systems' they have employed for minimizing waste. The results suggest the need for the development and implementation of a holistic range of systems in order to develop best practice, including waste minimization strategies, key performance indicators, and staff training and awareness. The implications for the sharing of best practice from the two case studies are also discussed.

Strategies for improving recycling behaviour within the Cornwall National Health Service (NHS) in the UK.

This paper examines strategies for improving recycling behaviour within the Cornwall National Health Service (NHS). Using quantitative (questionnaires and waste bin analyses) and qualitative (ethnography and interviews) methodologies, the study examined the waste management practices of staff from the Cornwall NHS. It was found that employee participation in waste recycling at work was low due to a range of factors including NHS focus and policies, group norms, and individual attitudes and beliefs about sustainable waste management. Recommendations for improving the sustainability of NHS, employee waste management practices, with a specific focus on recycling are included in the paper. These recommendations include measures focused towards both the NHS organization and individual staff members.