Prevalence and Cost of Routine Preoperative Care for Low-Risk Cataract Surgery a Decade after Choosing Wisely.

PURPOSE: Examine the frequency and cost of procedural clearance tests and examinations in preparation for low-risk cataract surgery among members of a commercial healthcare organization in the United States. Determine what characteristics most strongly predict receipt of preoperative care and the probability that preoperative care impacts postsurgical adverse events. DESIGN: Retrospective healthcare claims analysis and medical records review from a large, blended-health organization headquartered in Western Pennsylvania. PARTICIPANTS: Members aged ≥ 65 years who were continuously enrolled 6 months before and after undergoing cataract surgery from 2018 to 2021 and had approved surgery claims. METHODS: Preoperative exams or tests occurring in the 30 days before surgery were identified via procedural and diagnosis codes on claims of eligible members (e.g., Current Procedural Terminology codes for blood panels and preprocedural International Classification of Diseases, 10th Revision, Clinical Modification codes). Prevalence and cost were directly estimated from claims; variables predictive of preoperative care receipt and adverse events were tested using mixed effects modeling. MAIN OUTCOME MEASURES: Total costs, prevalence, and strength of association as indicated by odds ratios. RESULTS: Up to 42% of members undergoing cataract surgery had a physician office visit for surgical clearance, and up to 23% of members had testing performed in isolation or along with clearance visits. The combined costs for the preoperative visits and tests were $4.3 million (approximately $107-$114 per impacted member). There was little difference in member characteristics between those receiving and not receiving preoperative testing or exams. Mixed effects models showed that the most impactful determinants of preoperative care were the surgical facility and member's care teams; for preoperative testing, facilities were a stronger predictor than care teams. Adverse events were rare and unassociated with receipt of preoperative testing, exams, or a combination of the two. CONCLUSIONS: Rates of routine preoperative testing before cataract surgery appear similar to those prior to the implementation of the Choosing Wisely campaign, which was meant to reduce this use. Additionally, preoperative evaluations, many likely unnecessary, were common. Further attention to and reconsideration of current policies and practice for preoperative care may be warranted, especially at the facility level. FINANCIAL DISCLOSURE(S): The author(s) have no proprietary or commercial interest in any materials discussed in this article.

Healthcare waste management practice and associated factors among healthcare workers in public healthcare facilities of Southwest Shewa Zone, Oromia regional state, Ethiopia.

Poor management of waste can cause serious disease to healthcare personnel, cleaners, waste handlers, patients and the public. An observation-supported cross-sectional study was conducted to assess healthcare waste (HCW) management practice and professional, management and resource availability-associated factors among healthcare workers of 23 public health facilities in Southwest Shewa Zone, Oromia regional state, Ethiopia, 2021. A total of 424 health workers participated in this study. The level of proper healthcare waste management (HCWM) practice was 38.4%. Lack of knowledge on different methods of healthcare waste treatment (adjusted odds ratio (AOR): 0.101, 95% confidence interval (CI) (0.042, 0.242, p < 0.05)), lack of knowledge about the types of healthcare waste (AOR: 0.136, 95% CI (0.039, 0.481, p < 0.05)), lack of knowledge on the use of different colour-coded waste bin and safety box (AOR: 0.145, 95% CI (0.040, 0.520, p < 0.05)), and healthcare workers who had no training/orientation on HCWM practice (AOR: 0.396, 95% CI (0.245, 0.639, p < 0.05)) were less likely to practice effective HCWM compared to their counterparts. The current HCWM practices in studied health facilities was inadequate. Professional knowledge and availability of training were independently associated with HCWM practice. Therefore, regular orientation during employment and on-job training on HCWM practice, regular monitoring and supervision of HCWM are important. Further research should be conducted on the area of HCWM, and its associated environmental impacts by using more strong methods and wider health facilities.

Waste management beyond the COVID-19 pandemic: Bibliometric and text mining analyses.

The outbreak of the COVID-19 pandemic has significantly increased the demand for personal protective equipment, in particular face masks, thus leading to a huge amount of healthcare waste generated worldwide. Consequently, such an unprecedented amount of newly emerged waste has posed significant challenges to practitioners, policy-makers, and municipal authorities involved in waste management (WM) systems. This research aims at mapping the COVID-19-related scientific production to date in the field of WM. In this vein, the performance indicators of the target literature were analyzed and discussed through conducting a bibliometric analysis. The conceptual structure of COVID-19-related WM research, including seven main research themes, were uncovered and visualized through a text mining analysis as follows: (1) household and food waste, (2) personnel safety and training for waste handling, (3) sustainability and circular economy, (4) personal protective equipment and plastic waste, (5) healthcare waste management practices, (6) wastewater management, and (7) COVID-19 transmission through infectious waste. Finally, a research agenda for WM practices and activities in the post-COVID-19 era was proposed, focusing on the following three identified research gaps: (i) developing a systemic framework to properly manage the pandemic crisis implications for WM practices as a whole, following a systems thinking approach, (ii) building a circular economy model encompassing all activities from the design stage to the implementation stage, and (iii) proposing incentives to effectively involve informal sectors and local capacity in decentralizing municipal waste management, with a specific focus on developing and less-developed countries.

Designing reverse logistics network for healthcare waste management considering epidemic disruptions under uncertainty.

Population growth and recent disruptions caused by COVID-19 and many other man-made or natural disasters all around the world have considerably increased the demand for medical services, which has led to a rise in medical waste generation. The improper management of these wastes can result in a serious threat to living organisms and the environment. Designing a reverse logistics network using mathematical programming tools is an efficient and effective way to manage healthcare waste. In this regard, this paper formulates a bi-objective mixed-integer linear programming model for designing a reverse logistics network to manage healthcare waste under uncertainty and epidemic disruptions. The concept of epidemic disruptions is employed to determine the amount of waste generated in network facilities; and a Monte Carlo-based simulation approach is used for this end. The proposed model minimizes total costs and population risk, simultaneously. A fuzzy goal programming method is developed to deal with the uncertainty of the model. A simulation algorithm is developed using probabilistic distribution functions for generating data with different sizes; and then used for the evaluation of the proposed model. Finally, the efficiency of the proposed model and solution approach is confirmed using the sensitivity analysis process on the objective functions' coefficients.

Selection of healthcare waste management treatment using fuzzy rough numbers and Aczel-Alsina Function.

The COVID-19 pandemic led to an increase in healthcare waste (HCW). HCW management treatment needs to be re-taken into focus to deal with this challenge. In practice, there are several treatments of HCW with their advantages and disadvantages. This study is conducted to select the appropriate treatment for HCW in the Brcko District of Bosnia and Herzegovina. Six HCW management treatments are analyzed and observed through twelve criteria. Ten-level linguistic values were used to bring this evaluation closer to human thinking. A fuzzy rough approach is used to solve the problem of inaccuracy in determining these values. The OPA method from the Bonferroni operator is used to determine the weights of the criteria. The results of the application of this method showed that the criterion Environmental Impact ( C 4 ) received the highest weight, while the criterion Automation Level ( C 8 ) received the lowest value. The ranking of HCW management treatments was performed using MARCOS methods based on the Aczel-Alsina function. The results of this analysis showed that the best-ranked HCW management treatment is microwave (A6) while landfill treatment (A5) is ranked worst. This study has provided a new approach based on fuzzy rough numbers where the Bonferroni function is used to determine the lower and upper limits, while the application of the Aczel-Alsina function reduced the influence of decision-makers on the final decision because this function stabilizes the decision-making process.

Assessment of healthcare waste treatment methods using an interval-valued intuitionistic fuzzy double normalization-based multiple aggregation approach.

Healthcare waste management has been an extensively attractive topic recently since it is one of the key concerns regarding both environment and public health, predominantly in developing nations. The optimization of the treatment procedure for healthcare waste is indeed a complex "multi-criteria decision-making (MCDM)" problem that involves contradictory and interweaved critical criteria. To successfully handle this issue, this study extends the original method, named the "double normalization-based multi-aggregation (DNMA)" approach, with "interval-valued intuitionistic fuzzy sets (IVIFSs)" for decision-making problems taking criteria in terms of benefit or cost types. This method involves two target-based normalizations and three subordinate utility models. To estimate the criteria weights, we propose a new parametric divergence measure and discuss the feasibility of the developed divergence measure based on existing divergence measures for IVIFSs. Further, the developed framework is implemented to elucidate the "healthcare waste treatment (HCWT)" problem. The comparative and sensitivity analyses of the outcomes indicate that the proposed approach efficiently tackles the problem of HCWT selection. The outcomes show that steam sterilization (0.462) is the optimal one for HCWT. The prioritization options, obtained by presented approach, are dependable and suitable, which are steam sterilization ≻ microwave ≻ incineration ≻ landfilling.

Management of COVID-19 healthcare waste based on the circular economy hierarchy: A critical review.

The overall objective of this work was to conduct a critical literature review on the application of the circular economy (CE) hierarchy for the management of COVID-19 healthcare waste (HCW). To describe the problem created by COVID-19 HCW, first, the subsystems of the overall management system, including generation, segregation, classification, storage, collection, transport, treatment and disposal, were reviewed and briefly described. Then, the CE hierarchy using the 10R typology was adapted to the management of COVID-19 HCW and included the strategies Refuse, Reduce, Resell/Reuse, Repair, Reprocess, Refurbish, Remanufacture, Repurpose, Recycle and Recover (energy). Disposal was added as a sink of residues from the CE strategies. Using the detailed 10R CE hierarchy for COVID-19 HCW management is the novelty of this review. It was concluded that R-strategy selection depends on its position in the CE hierarchy and medical item criticality and value. Indicative HCW components, which can be managed by each R-strategy, were compiled, but creating value by recovering infectious downgraded materials contaminated with body fluids and tissues is not currently possible. Therefore, after applying the circular solutions, the end of pipe treatment and disposal would be necessary to close material cycles at the end of their life cycles. Addressing the risks, knowledge gaps and policy recommendations of this article may help to combat COVID-19 and future pandemics without creating environmental crises.

Waste audits in healthcare: A systematic review and description of best practices.

Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.

Management of healthcare waste collection and segregation for developing countries.

Healthcare waste (HCW) consists of hazardous material that may be radioactive, toxic or infectious. Inappropriate treatment and disposal of HCW may pose health risks to humans indirectly through the release of pathogens and toxic pollutants into the environment. The biggest problem in HCW management is its handling, which causes anxiety over sorting and categorizing the waste. Hence, the current study identifies and addresses the challenges towards sustainable environmental development by managing infectious HCW in developing countries. Fuzzy Delphi method is used in the present study to carefully examine the barrier drawn from the literature and experts' opinions. The number of barriers taken into consideration for study are 30, which are then grouped into four main categories, that is, social, environmental, technological and economic barriers. Additionally, a hybrid strategy based on the fuzzy decision-making trial and evaluation laboratory is developed in this work to examine the significance and interrelationships of the identified barrier. The research outcome is a hierarchy and classification model based on the relative importance of the barriers. The results of this study indicate that: 'Lack of segregation', 'Inconsistency in waste collection', 'Unregulated disposal site' and 'Inadequate programme for training and awareness' require quick action. The conclusions obtained through the study would facilitate the preparation of check sheets for documenting HCW management procedures by the healthcare administration and Pollution Control Boards. Understanding the priority cause-group barrier would improve the long-term protection of the hospital environment from the spread of infection caused by the HCW.

Effect of a waste management intervention program on knowledge, attitude, and practice (KAP) of nurses and housekeepers: a quasi-experimental study, Egypt.

BACKGROUND: Improper healthcare waste management practice is alarming in developing countries because resources are inadequate and waste management is often delegated to poorly educated and untrained laborers. This study aimed to compare the pre-KAP versus post-KAP towards the waste management program for nurses and housekeepers. In addition, it aimed to explore possible factors affecting the pre- and post-KAP in Mansoura Emergency University Hospital, Egypt. SUBJECTS AND METHODS: One hundred thirty-three newly employed nurses, housekeepers, and those who need refreshment training as nominated by head nurses and link occupational health and safety nurses in the hospital were recruited for the study. The study's intervention included multiple training sessions using a PowerPoint presentation in Arabic with appropriate illustrations followed by an open discussion. An Arabic self-administered questionnaire containing demographic and occupational history, knowledge (27 questions), attitude (10 questions), and practice (9 questions) was used pre- and post-intervention. RESULTS: The overall KAP scores among the studied healthcare workers were significantly higher after the intervention. The pre- and post-knowledge scores were significantly different with respect to education, job description, and duration of employment (p < 0.05). The post-attitude scores were significantly different with respect to education and job description only (p < 0.05). The total pre-practice scores were significantly different with respect to education and job description (p < 0.05). However, the post-practice scores were significantly different with respect to sex, age, education, and job description (p < 0.05). CONCLUSION: There was a significant improvement in the KAP scores post-intervention. The post-knowledge and attitude scores were significantly better in nurses and participants with a higher education. The post-practice score was significantly better for females, participants with an age ≥ 30 years, higher education, and nursing jobs. The combination of training and supervision was crucial for the success of waste management programs. Higher education levels are required for housekeepers to be capable of gaining better knowledge, follow rules, and be ready for any challenges in the future.

An assessment tool for healthcare waste management in Brazilian municipalities during the COVID-19 pandemic.

The COVID-19 pandemic has put healthcare waste management (HCWM) systems under pressure worldwide. In Brazil, where municipalities routinely experience challenges in ensuring suitable disposal of healthcare waste (HCW), the pandemic has made this even more challenging. Therefore, the creation of tools and methods to help in municipal HCWM during the COVID-19 pandemic is of utmost importance. This article presents the development of a tool to evaluate HCWM in Brazilian municipalities during the pandemic. Following guidelines of health agencies, 56 indicators and 18 criteria were selected to create a tool called the municipal healthcare waste management assessment index (iMHWaste). These indicators and criteria were divided into operational, environmental, political-economic, educational and social groups. Each group considers essential aspects for sustainable management, safety and reduced spread of coronavirus. The analytic hierarchy process was used to assign the weights attributed to the groups and criteria. The indicators can be measured according to a standardized rating scale proposed for each one. These elements were aggregated with a weighted linear combination, into an equation that allows the calculation of the iMHWaste. The index is rated on a scale of 0-1. The index was applied in a Brazilian municipality considering a pre-pandemic HCWM. With the identification of the municipality's management weaknesses, it was possible to identify the main actions that should be prioritized in the transition from traditional HCWM during the pandemic.

Impact of COVID-19 on healthcare waste generation: Correlations and trends from a tertiary hospital of a developed country.

The SARS-CoV-2 (COVID-19) coronavirus pandemic has represented an emergency not only from a clinical point of view, but also for the environment due to the largely increased waste disposal. This study aimed at estimating, in the context of current trends, the increase in healthcare waste (HW) generation during the outbreak, based on data from a tertiary hospital. From the purveying office statements of 'SS Antonio e Biagio e Cesare Arrigo' Hospital of Alessandria (Italy), monthly HW generation data from January 2015 to March 2021 were retrospectively retrieved. Trends and COVID's impact were evaluated by Interrupted Time Series (ITS) design with linear regression models. Locally Weighted Scatterplot Smoothing was used to model the relation between infectious HW generation and proportion of COVID-related bed days. HW generation rose from 35.9 ± 3.8 tonnes month-1 (2.4 ± 0.2 kg per patient-day, kg PD-1) in 2015-2019, to 46.3 ± 6.0 tonnes month-1 (3.3 ± 0.7 kg PD-1) during the outbreak. The increasing trend was not appreciably modified as for its slope (p = 0.363), while a significant level change was found between baseline and outbreak (+ 0.72 kg PD-1, p < 0.001). The proportion of COVID-related bed days non-linearly affected the infectious HW generated per patient-day, with steeper increases for proportions above 20%. The study showed a significant rise in HW generation in 2020-2021, reasonably due to the COVID outbreak; in addition, the generally increasing trend was not affected. Therefore, urgent measures are needed to conciliate safety requirements with HW generation issues.

A Cluster-based Stratified Hybrid Decision Support Model under Uncertainty: Sustainable Healthcare Landfill Location Selection.

Nowadays, healthcare waste management has become one of the significant environmental, health, and social problems. Due to population and urbanization growth and an increase in healthcare waste disposals according to the growing number of diseases and pandemics like COVID-19, disposal of healthcare waste has become a critical issue. Authorities in big cities require reliable decision support systems to empower them to make strategic decisions to provide safe disposal methods with a prospective vision. Since inappropriate healthcare waste management systems would definitely bring up dangerous environmental, social, health, and economic issues for every city. Therefore, this paper attempts to address the landfill location selection problem for healthcare waste using a novel decision support system. Novel decision support model integrates K-means algorithms with Stratified Best-Worst Method (SBWM) and a novel hybrid MARCOS-CoCoSo under grey interval numbers. The proposed decision support system considers waste generate rate in medical centers, future unforeseen but potential events, and uncertainty in experts' opinion to optimally locate required landfills for safe and economical disposal of dangerous healthcare waste. To investigate the feasibility and applicability of the proposed methodology, a real case study is performed for Mazandaran province in Iran. Our proposed methodology could efficiently deal with 79 medical centers within 4 clusters addressing 9 criteria to prioritize candidate locations. Moreover, the sensitivity analysis of weight coefficients is carried out to evaluate the results. Finally, the efficiency of the methodology is compared with several well-known methods and its high efficiency is demonstrated. Results recommend adherence to local rules and regulations, and future expansion potential as the top two criteria with importance values of 0.173 and 0.164, respectively. Later, best location alternatives are determined for each cluster of medical centers.

Secondary overtriage of isolated facial trauma.

DESIGN: Retrospective chart review. SETTING: Academic, tertiary care, level I trauma center in a rural state. BACKGROUND: Unnecessary transfer of certain facial trauma patients results in a burden of time, money, and other resources on both the patient and healthcare system; identification and development of outpatient treatment pathways for these patients is a significant opportunity for cost savings. OBJECTIVES: To investigate the treatment and disposition of un-complicated, stable, isolated facial trauma injuries transferred from outside hospitals and determine the significance of secondary overtriage. METHODS: Retrospective chart review utilizing our institutional trauma database, including patients transferred to our emergency department between January 2012 and December 2017. Patients were identified by ICD9 or ICD10 codes and only those with isolated facial trauma were included. RESULTS: We identified 538 isolated facial trauma patients who were transferred to our institution during the study period. The majority of those patients were transferred via ground ambulance for an average of 76 miles. Overall, 82% of patients (N = 440) were discharged directly from our institution's emergency department. Almost 30% of patients did not require any formal treatment for their injuries; the potential savings associated with elimination of these unnecessary transfers was estimated to be between $388,605 and $771,372. CONCLUSIONS: We identified a high rate of patients with stable, isolated facial trauma that could potentially be evaluated and treated without emergent transfer. The minimization of these unnecessary transfers represents a significant opportunity for cost and resource utilization savings. LEVEL OF EVIDENCE: 2b- Economic and Cost Analysis.

Selection of healthcare waste disposal firms using a multi-method approach.

The aim of this study is to propose a hybrid multi criteria decision making model with a linear programming (LP) model to tackle the issue of safe disposal of hazardous and infectious healthcare waste. For this, ten criteria in this study have been identified from literature and field surveys which are modelled using Decision making trial and evaluation (DEMATEL) and Analytic network process (ANP) methods to select the best disposal firm i.e. single sourcing for a hospital. We found that Experience of the firm, Technology for disposal, and Waste collection infrastructure acts as the most vital criteria in selecting a healthcare waste disposal firm for single sourcing. Furthermore, to optimize the total value of disposal and mitigating the risk involved in disposing waste through single sourcing; the LP model considering constraints such as waste lose constraint and waste processing constraint etc. Is solved for multiple sourcing using Lingo 18.0. The solution to LP results into allocation of 500, 500, and 1000 (kg/day) disposables to healthcare waste disposal firms D1, D2 and D3, respectively. The multi-method approach proposed in this study helps the hospital management in selecting economically, socially, and environmentally sustainable healthcare waste disposal firm.

Framework for PESTEL dimensions of sustainable healthcare waste management: Learnings from COVID-19 outbreak.

The COVID-19 pandemic has put the world economy at an unprecedented position and protecting society from the infection is at the core of all measures. As the COVID-19 virus stays longer on plastic and stainless steel materials, hence the healthcare wastes (HCW), coming out of the treatment of COVID-19 infected patients can be one of the potential route for transmission of infection. Therefore, the present study analyses the dimensions of sustainable HCWM by using a multi-method approach: PESTEL (political, economic, social, technological, environmental and legal) analysis, TISM (total interpretive structural modeling) and fuzzy- MICMAC (cross-impact matrix multiplication applied to classification) analysis. The opted research framework yields 17 PESTEL dimensions of sustainable HCWM during the COVID-19 outbreak through the literature survey and experts' discussions. Then, the TISM methodology developed a hierarchical digraph of all the 17 dimensions of sustainable HCWM based on the interrelationships. Fuzzy-MICMAC analysis classified all 17 PESTEL dimensions into four groups depending upon their driving and dependence powers. The study concluded that the policy framework for targeting political, legal and environmental issues should be the immediate concern of the worldwide governments and health officials. The effluent control and compliance to environmental laws being the output dimensions should be tracked regularly for ensuring the cleaner production in healthcare services. The PESTEL analysis will help the hospitals' managers and policymakers to understand the macro-environment surrounding the HCWM.

The interplay of circular economy with industry 4.0 enabled smart city drivers of healthcare waste disposal.

Generation of healthcare waste from different patient care activities in hospitals, pathology labs and research centres has been a matter of great concern for environmental and social bodies across the world. This concern comes from its infectious and hazardous nature which brings life taking disease such as human immunodeficiency virus and Hepatitis-B. Moreover, with the outbreak of corona virus disease 2019 (COVID-19) pandemic across the world, healthcare waste has become even more infectious like never before and showing its potential for claiming lives if not disposed properly. Additionally, the COVID-19 has put up another challenge in terms of exponentially increasing demand for personal protective equipments for healthcare workers such as doctors, nurses, ward boys, and sanitation workers. In this paper, seven criteria related to smart healthcare waste disposal system infused by circular economy aspects to recover value from disposables are identified and analysed using a decision making trial and evaluation laboratory (DEMATEL) method. The criteria have been prioritized by its importance and net cause and effect relationship through a causal diagram. Two criteria, (i) digitally connected healthcare centres, waste disposal firms and pollution control board, and (ii) providing a pollution control board's feedback app to public and other stakeholders, feature as strong reasons for a smart healthcare waste disposal system. Conclusively, this study provides a causal relationship model among the intertwined drivers of industry 4.0 and circular economy for developing a smart healthcare waste disposal system enriched with the benefits of circular economy.

Generation of infectious waste during the COVID-19 pandemic: The case of a Brazilian hospital.

Coronavirus-19 disease (COVID-19) acquired pandemic status in March 2020. The new virus has caused serious implications in the healthcare services management, including several sectors, among them the generation of waste. Healthcare wastes (HCW) generation increased along pandemic representing a health problem due to potentially infected ones. From this perspective, the study sought to analyse the challenges and changes imposed by COVID-19 in the HCW management in a large public hospital from Brazil. For this purpose, data about the Contingency Plan prepared by the hospital and HCW generation from 2017 to 2020 were used, analysed by statistical methods. When dealing with the Contingency Plan, the Brazilian hospital adopted measures similar to other hospitals around the world as described by the literature, such as: adoption of new protocols, specific team assigned to manage actions and training of professionals and suspension of elective surgeries. Regarding the generation of HCW, there was a significant increase in the mass of biological waste with a high risk of infection. The waste of this group increased from March 2020, coinciding with the start of care for the patients infected by COVID-19. The contribution of this type of waste to total generation jumped from approximately 0.2% in previous years to almost 5% in 2020. In addition, a reduction in the average of total waste generated in kilogrammes per bed per day from 2017 to 2019 was indicated compared to the 2020. COVID-19 pandemic led to major challenges for hospitals that had to care for patients infected with the SARS-CoV-2 virus, including new protocols, changing the work shifts and training the teams in the new procedures. The biological waste with a high risk of infectiousness also increased 30 times.

Sustainable waste management of medical waste in African developing countries: A narrative review.

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method - if not applying the right technologies - potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

Assessing the management of healthcare waste for disease prevention and environment protection at selected hospitals in Kinshasa, Democratic Republic of Congo.

Incineration is the most used healthcare waste (HCW) disposal method. Disease outbreaks due to Ebola virus and SARS-CoV2 require attention to HCW management to avoid pathogens spread and spillover. This study describes HCW management prior to incineration and hospital incinerators performance by analysing bottom ashes from hospitals in Kinshasa, Democratic Republic of Congo. We used semi-structured interviews to capture information on pre-incineration waste management and analysed the chemical composition of 27 samples of incinerator bottom ashes using the energy dispersive X-ray fluorescence. Neither sorting nor waste management measures were applied at hospitals surveyed. Incinerator operators were poorly equipped and their knowledge was limited. The bottom ash concentrations of cadmium, chromium, nickel and lead ranged between 0.61-10.44, 40.15-737.01, 9.11-97.55 and 16.37-240.03 mg kg-1, respectively. Compared to Chinese incinerator performance, the concentrations of some elements were found to be lower than those from China. This discrepancy may be explained by the difference in the composition of HCW. The authors conclude that health care waste in Kinshasa hospitals is poorly managed, higher concentrations of heavy metals are found in incinerator bottom ashes and the incinerators quality is poor. They recommend the strict application of infection prevention control measures, the training of incinerator operators and the use of high-performance incinerators.