Reducing Overuse of 3-Day Repeat Type and Screen Testing across an 11-Hospital Safety Net System.

BACKGROUND: According to the American Association of Blood Banks, a Type and Screen (T&S) is valid for up to three calendar days. Beyond a limited number of clinical indications such as a transfusion reaction, repeat T&S testing within 3 days is not warranted. Inappropriate repeat T&S testing is a costly medical waste and can lead to patient harm. OBJECTIVE: To reduce inappropriate duplicate T&S testing across a large, multihospital setting. SETTING: The largest urban safety net health system in the USA, with 11 acute care hospitals. INTERVENTIONS: Our first intervention involved adding the time elapsed since the last T&S order into the order and the process instructions that described when a T&S was indicated. The second intervention was a best practice advisory that triggered when T&S was ordered before the expiration of an active T&S. MAIN MEASURES: The primary outcome measure was the number of duplicate inpatient T&S per 1000 patient days. KEY RESULTS: Across all hospitals, the weekly average rate of duplicate T&S ordering decreased from 8.42 to 7.37 per 1000 patient days (12.5% reduction, p < 0.001) after the first intervention and to 4.32 per 1000 patient days (48.7% reduction, p < 0.001) after the second intervention. Using linear regression to compare pre-intervention to post-intervention 1, the level difference was - 2.46 (9.17 to 6.70, p < 0.001) and slope difference was 0.0001 (0.0282 to 0.0283, p = 1). For post-intervention 1 to post-intervention 2, the level difference was - 3.49 (8.06 to 4.58, p < 0.001) and slope difference was - 0.0428 (0.0283 to - 0.0145, p < 0.05). CONCLUSIONS: Our intervention successfully reduced duplicate T&S testing using a two-pronged electronic health record intervention. The success of this low effort intervention across a diverse health system provides a framework for similar interventions in various clinical settings.

Resource utilization of medical waste incineration fly ash to activate peroxydisulfate for tetracycline degradation: Synergy between adsorption and PDS activation.

Medical waste incineration fly ash (MWI FA) is classified as a hazardous solid waste. Therefore, the development of recycling technologies to convert MWI FA into useful products is necessary and challenging. In this study, we developed a sustainable approach for preparing a catalyst through the pyrolysis of water-washed MWI FA (WW FA-x, where x corresponds to the pyrolysis temperature). Subsequently, it was applied as a potent peroxydisulfate (PDS) activator to remove tetracycline (TC) from water. The results showed that the WW FA-800 exhibited remarkable adsorption performance as well as highly efficient catalytic activation of PDS, with a 115 mg/g maximum TC adsorption capacity and 93.5% (reaction kinetic rate = 315 µmol/g/h) TC removal within 60 min. A synergistic effect was achieved by adsorption and PDS activation. TC degradation was primarily driven by non-radical (1O2 and electron transfer) processes. WW FA-800 possesses multiple active sites, including defects, π-π*, O-CO groups, Fe0, and Cu(I). Three possible pathways for TC decomposition have been proposed, with the majority of intermediates exhibiting less toxicity than TC. Furthermore, the WW FA/PDS system exhibited an excellent anti-interference ability, and universality in the degradation of various organic contaminants. Notably, energy consumption was minimal, approximately 2.80 kWh/(g·TC), and the leachability of heavy metals in the WW FA-800 was within acceptable limits. This study provides a MWI FA recycling route for the development of highly active catalysts.

Medical waste incineration fly ash-based magnesium potassium phosphate cement: Calcium-reinforced chlorine solidification/stabilization mechanism and optimized carbon reduction process strategy.

The traditional solidification/stabilization (S/S) technology, Ordinary Portland Cement (OPC), has been widely criticized due to its poor resistance to chloride and significant carbon emissions. Herein, a S/S strategy based on magnesium potassium phosphate cement (MKPC) was developed for the medical waste incineration fly ash (MFA) disposal, which harmonized the chlorine stabilization rate and potential carbon emissions. The in-situ XRD results indicated that the Cl- was efficiently immobilized in the MKPC system with coexisting Ca2+ by the formation of stable Ca5(PO4)3Cl through direct precipitation or intermediate transformation (the Cl- immobilization rate was up to 77.29%). Additionally, the MFA-based MKPC also demonstrated a compressive strength of up to 39.6 MPa, along with an immobilization rate exceeding 90% for heavy metals. Notably, despite the deterioration of the aforementioned S/S performances with increasing MFA incorporation, the potential carbon emissions associated with the entire S/S process were significantly reduced. According to the Life Cycle Assessment, the potential carbon emissions decreased to 8.35 × 102 kg CO2-eq when the MFA reached the blending equilibrium point (17.68 wt.%), while the Cl- immobilization rate still remained above 65%, achieving an acceptable equilibrium. This work proposes a low-carbon preparation strategy for MKPC that realizes chlorine stabilization, which is instructive for the design of S/S materials.

A study of indoor air pollution caused by disinfection equipment as a consequence of infectious waste management.

Infectious waste disinfection is an essential process in medical waste management that may cause release of some pollutants. In this study, the PAHs concentration at the disinfection was investigated. The change in the release rate of PAHs in two including infectious waste reduction and increasing the segregation ratio was estimated. The results showed that the PAHs concentration was 1172 - 2066 ng/m3. The specific concentration of PAHs was 852 ng/ton of infectious waste in average. The annual emission of the PAHs resulting from infectious waste disinfection is estimated to be 612.6 kg. Reduction of infectious waste caused by redefining infectious waste and increasing the segregation ratio leads to reduction of PAHs concentration by 50%. Increasing the ratio of segregation and redefinition of infectious waste that led to reduced waste loading volume are essential measures that reduce the emissions of pollutants as by-products of disinfection.

Waste management in primary healthcare centers in Saudi Arabia: a policy analysis.

Medical waste poses high risks to healthcare workers, patients, the environment, and public health. Governments have adopted measures and enacted policies to ensure proper medical waste management. Through a retrospective policy analysis, we analyzed the waste management policy for primary healthcare centers in Saudi Arabia. By adopting Walt and Gilson's health policy analysis framework, we conducted a thematic analysis of documents to analyze the policy context, process, actors, and content. Contextual factors including accreditation, the Saudi Vision-2030 and the healthcare transformation plan contributed to the development of the policy. The policy was adapted from a regional policy that was enacted about 15 years ago. The policy content overlooked components relevant to the specific context of primary healthcare centers. Lack of training and cooperation among stakeholders challenged successful implementation and thus compliance with the policy. Respective stakeholders must take further actions to ensure implementation fidelity and sustainability of the policy.

Does medical waste research during COVID-19 meet the challenge induced by the pandemic to waste management?

The COVID-19 pandemic has resulted in an unprecedented amount of medical waste, presenting significant challenges for the safe disposal of hazardous waste. A systematic review of existing research on COVID-19 and medical waste can help address these challenges by providing insights and recommendations for effective management of the massive medical waste generated during the pandemic. This study utilized bibliometric and text mining methods to survey the scientific outcomes related to COVID-19 and medical waste, drawing on data from the Scopus database. The results show that the spatial distribution of medical waste research is unbalanced. Surprisingly, developing countries rather than developed countries lead research in this area. Especially, China, a major contributor to the field, has the highest number of publications and citations, and is also a centre of international cooperation. The main study authors and research institutions are also mainly from China. And the research on medical waste is a multidisciplinary field. Text mining analysis shows that COVID-19 and medical waste research is mainly organized around four themes: (i) medical waste from personal protective equipment; (ii) research on medical waste in Wuhan, China; (iii) threats of medical waste to the environment and (iv) disposal and management of medical waste. This would serve to better understand the current state of medical waste research and to provide some implications for future research.

Reflections on COVID-19 pandemic and waste management in developing countries: A case study in São Paulo city, Brazil.

COVID-19 pandemic has changed several aspects in human behaviour, whereas population mobility patterns have been strongly affected by social distancing. In parallel, changes in solid waste generation patterns have been reported worldwide. This work assessed the influence of the COVID-19 pandemic on waste generation and collection in São Paulo city, Brazil, the largest city of Latin America. Data on nine types of wastes collected between 2013 and 2021 were obtained, and the quantities of wastes collected before and during the pandemic were compared. These data were also discussed in light of data on COVID-19 cases and rates of social distancing and mobility. An increase in the amount of recyclables collected during the first wave of COVID-19 (March to September 2020) was observed. Decreases in the quantities of construction, demolition and bulky wastes (first wave of COVID-19) and farmers market wastes (second wave - October 2020 to February 2021) were also evidenced. The quantities of medical wastes collected during the pandemic significantly increased. The amount of residential wastes was lower than the mean for the pre-pandemic period during the first months of COVID-19. Thus, changes in lifestyle and consumption patterns of the population of São Paulo city seem to have affected solid waste generation during the pandemic, which reinforces the need of implementing solid waste management policies based on a diagnostic that characterise and consider these changes.

The evolutionary path of medical waste management research: Insights from co-citation and co-word analysis.

Over the past decades, medical waste management (MWM) has evolved into a paramount global challenge, intertwining environmental sustainability and public health dimensions. This manuscript traces the paradigm shift from the foundational Basel Convention of 1989 to the significant sway of World Health Organization publications on contemporary debates. Utilizing a mixed approach strategy that blended qualitative and quantitative techniques, the research employed extensive literature review, co-citation and co-word analysis methodologies to ascertain the direction of contemporary trends in MWM. Within the scope of the research findings, current strategies reveal noticeable gaps, especially those that lack sound policy structures, comprehensive insights and effective operational frameworks. Co-citation evaluations spotlight predominant themes in academic references. Foremost among them are the socioeconomic factor, environmental significance, medical waste (MW) stabilization and sustainable society, sequenced by cluster magnitude. Co-word analysis unveils that, despite the long-standing presence of incineration plants, pyrolysis has, since 2016, prioritized environmental considerations. The recycling ethos peaked in 2014, but the sustainability paradigm burgeoned in 2020, with the 'circular economy' gaining momentum in 2021. Emerging trend analysis underscores the mounting significance of circular waste technologies and sustainability as indispensable solutions. Results demonstrate MW advancements and highlight emerging trends shaping the future of the field. The research concludes by accentuating the necessity of global collaborative efforts, integrating cutting-edge technologies and infusing sustainability and circularity tenets into societal frameworks to navigate MWM's intricate landscape. Future research trajectories, including wastewater governance, novel mobile waste disposal strategies and a cyclic waste classification paradigm, are proposed.

Green Dialysis: Let Us Talk about Dialysis Fluid.

BACKGROUND: Hemodialysis is one of the most resources consuming medical intervention. Due to its concept, the proper amount of dialysis fluid passed through dialyzer is crucial to obtain the expected outcomes. The most frequent source of dialysis fluid is production from liquid concentrate (delivered in containers or plastic bags) in dialysis machine. Alternatively, concentrates for dialysis may be produced in dialysis center by dilution in mixing devices dry or semidry premixed compounds connected with system of central dialysis fluid delivery system. Dialysate consumption depends on various factors like type of hemodialysis machine, session duration, prescribed flow, etc. Summary: Modern hemodialysis machines are equipped with the modules which automatically reduce flow rate of dialysis fluid to the patient blood flow and minimize dialysate consumption during preparation and after reinfusion. Smart using of available options offered by manufacturers allows to save additional portion of acid concentrate and water. The weight of concentrates to be delivered to the dialysis center is the major factor influencing the cost (financial and environmental) of transportation from the manufacturer to the final consumer. The crisis on the energy carriers market and extremely high fuel prices made the transportation cost one of the significant costs of the treatment, which must be bear by supplier and finally influence on the price of goods. KEY MESSAGES: The careful choice of the concentrate delivery system can improve cost-effectiveness of dialysis. Such solutions implemented in dialysis unit helps make significant savings and decrease the impact on natural environment by carbon footprint reduction.

Microbial strategies for degradation of microplastics generated from COVID-19 healthcare waste.

COVID-19 pandemic has led to the generation of massive plastic wastes, comprising of onetime useable gloves, masks, tissues, and other personal protective equipment (PPE). Recommendations for the employ of single-use disposable masks made up of various polymeric materials like polyethylene, polyurethane, polyacrylonitrile, and polypropylene, polystyrene, can have significant aftermath on environmental, human as well as animal health. Improper disposal and handling of healthcare wastes and lack of proper management practices are creating serious health hazards and an extra challenge for the local authorities designated for management of solid waste. Most of the COVID-19 medical wastes generated are now being treated by incineration which generates microplastic particles (MPs), dioxin, furans, and various toxic metals, such as cadmium and lead. Moreover, natural degradation and mechanical abrasion of these wastes can lead to the generation of MPs which cause a serious health risk to living beings. It is a major threat to aquatic lives and gets into foods subsequently jeopardizing global food safety. Moreover, the presence of plastic is also considered a threat owing to the increased carbon emission and poses a profound danger to the global food chain. Degradation of MPs by axenic and mixed culture microorganisms, such as bacteria, fungi, microalgae etc. can be considered an eco-sustainable technique for the mitigation of the microplastic menace. This review primarily deals with the increase in microplastic pollution due to increased use of PPE along with different disinfection methods using chemicals, steam, microwave, autoclave, and incineration which are presently being employed for the treatment of COVID-19 pandemic-related wastes. The biological treatment of the MPs by diverse groups of fungi and bacteria can be an alternative option for the mitigation of microplastic wastes generated from COVID-19 healthcare waste.

Patients' knowledge and awareness of safe handling of oral anticancer agents at Sultan Qaboos University Hospital in Oman.

BACKGROUND: Safe handling of oral anticancer agents is of great concern. There is a lack of clear, national guidelines on how patients can safely handle and dispose of unwanted medications. We aimed to evaluate the safe handling, storage, and disposal of oral anticancer drugs among cancer patients and caregivers at home. METHOD: This cross-sectional survey of adult cancer patients (or their adult caregivers) used a closed-ended questionnaire from May 2019 to March 2020. RESULTS: A total of 257 patients (50 ± 15 years; range: 18-93 years) were enrolled; however, only 91% (233/257) reported self-administering oral anticancer medications. Caregivers were more likely to administer oral anticancer agents for patients ≥60 years than those <40 years old (63% vs. 8%; P = 0.001). Most patients (52%; 133/257) did not wash their hands after administering the drug; 74% (164/222) of the respondents reported that their medications were kept in a bedroom cabinet, while 18% (40/222) stored their medications in a refrigerator, and 5% (12/222) in a kitchen cabinet. A total of 55% (68/124) of patients returned their excess oral chemotherapy medications to the hospitals; however, 36% (45/124) disposed of their unused oral chemotherapy drugs in a household garbage container. CONCLUSION: While two-thirds of patients stored their oral anticancer medications properly, more than half used inappropriate handling procedures. Disposal practices were inconsistent and did not adhere to the reported international guidelines.

Biodegradation of di-2-ethylhexyl phthalate by Bacillus firmus MP04 strain: parametric optimization using full factorial design.

Di-2-ethylhexyl phthalate (DEHP) is used as a plasticizer in making plastics and released from landfills. This study attempted to degrade DEHP using microbial isolates. Isolates of Bacillus spp. were tested for their efficacy in degrading DEHP. Degradation was assessed using liquid chromatography-mass spectrometry (LC-MS). The most efficient DEHP degradation was achieved by Bacillus firmus MP04, which has been identified as Bacillus firmus MP04. This strain was found to use DEHP as the sole source of carbon without carbon source supplementation. Full factorial design was used to optimize the conditions for DEHP degradation which revealed the suitability of pH 7, 5% salt concentration, 20 to 37 °C temperature, and yeast extract as a nitrogen source. LC-MS elucidated the possible degradation mechanism via benzoic acid formation. However, prolonged incubation formed a typical compound denatonium benzoate due to reactions with other compounds. As maximum degradation was achieved in 4 days, prolonged incubation is not suggested. It can be concluded that new strain Bacillus firmus MP04 is the most efficient strain among all the tested strains for DEHP degradation.

Salvageable waste associated with intravitreal injections: A local medical waste management approach.

BACKGROUND: Healthcare waste management is a globally challenging issue with an increased prevalence of disposable, single-use materials in developed countries and a rapidly ageing population continuing to drive an increase in the use of medical resources. One manifestation of this within ophthalmology is the increasing number of intravitreal injections given for conditions such as age-related macular degeneration and diabetic macular oedema. METHODS: A prospective controlled cohort study was performed over 5 weeks in 2021 during which two sites were selected to compare different approaches to sorting the waste generated by intravitreal injections. At Site A all waste associated with these injections was placed in standard hospital waste bins. Site B was the intervention arm where a real-time sorting of waste occurred. The number of injections given and waste amounts were recorded. RESULTS: 116 and 286 injections were given at Sites A and B, respectively over the study period. Site A generated an average of 470.7 g of waste per injection compared with 175.1 g at our intervention site. This represents a 62.8% reduction (p < 0.001). At Site B, where waste was sorted, a total of 50.1 kg of medical waste was generated from these injections during the study period of which 33.8 kg (67.5%) was salvageable. CONCLUSIONS: This is the first quantification of the medical waste associated with intravitreal injections, a burgeoning treatment for macular degeneration and diabetic retinopathy among other conditions. This study demonstrates a significant reduction in the amount of medical waste produced using an easily implementable real-world methodology.

Pyrolysis behavior, kinetics, and thermodynamics of waste pharmaceutical blisters under CO2 atmosphere.

The disastrous impact of COVID-19 pandemic has caused a significantly increased production and use of pharmaceutical drugs, which is accompanied by the rapid generation of waste pharmaceutical blisters (WPBs). Nonetheless, its treatment has not gained appropriate attentions and a perceptible process development was not achieved. In this study, the WPBs pyrolysis in CO2 atmosphere was conducted as well as the thermodynamics and kinetics were investigated. The thermogravimetric analysis revealed that the WPBs decomposition could be divided into two stages of 25 - 365 °C and 365 - 900 °C with mass loss of 56.5 - 60.5 wt% and 22.5 - 25.9 wt%, respectively. Fourier-transform infrared spectroscopy analysis indicated the dechlorination process initiating at ∼300 °C. The simultaneous asymmetric stretching of HCl and stretching vibration of C-Cl bond was detected in the range of 2600 - 3250 cm-1 and 660 - 750 cm-1, respectively. The dechlorination reactions were almost complete at ∼520 °C and minor peaks (2900 -3100 cm-1) due to C-H vibrations were observed. Gas chromatography-mass spectrometry analysis indicated that the evolved products included alkanes, benzene, olefin, as well as HCl. The cycloalkenes content significantly increased during the second conversion stage, implying the addition reactions between alkanes and olefins. The apparent activation energy was calculated using three model-free methods and the values from Flynn-Wall-Ozawa model increased from 142.0 to 255.8 kJ·mol-1 with an average value of 147.4 kJ·mol-1. The methods of Coats-Redfern as well as Malek were applied to determine the reaction mechanism. The one-dimensional diffusion model was more reliable to describe the WPBs pyrolysis. This study will represent a significant reference case for the thermochemical conversion of multilayer packing waste and facing the increasing demand for the medical waste recycling.

The Green Maternity project: A midwife-led initiative to promote correct waste segregation on an Australian postnatal ward.

AIMS: Healthcare waste production is a significant contributor to carbon emissions, negatively impacting the environment. Ineffective healthcare waste disposal results in greater measures to manage it which is costly to both the environment and healthcare organizations. This study aimed to improve waste management in a tertiary maternity hospital. Specifically, the impact of a midwife-led intervention to improve waste segregation, staff knowledge and attitudes and waste management-related costs was investigated. DESIGN: A multi-method study including pre- and post-intervention staff waste management knowledge and attitude surveys and waste audits of bins located on the postnatal ward. METHODS: The intervention included education sessions, posters and signage by waste bins and monthly newsletters distributed throughout 2021 to raise staff awareness of correct waste segregation processes. Pre- and post-intervention surveys were distributed in early 2021 and early 2022, respectively. The waste audits occurred on three occasions, January, July and December of 2021. The waste audit included total waste in kilograms (kg), waste in kg by segregation and identification of correct and incorrect segregation. Waste audit and quantitative staff survey data were analysed using descriptive statistics and chi square. Qualitative data from the staff surveys were analysed using content analysis. RESULTS: Knowledge and attitudes to waste management were similar across pre- and post-intervention staff surveys. Knowledge of accurate allocation of specific items to waste streams was variable with errors identified in both the pre- and post-surveys. Waste audit data showed reductions in clinical waste at each measurement, with a 71.2% decrease in clinical waste from baseline to the final audit. Accuracy of waste segregation also improved from the baseline to final audit, resulting in a 48% reduction in waste management costs. CONCLUSION: The midwife-led initiative improved waste segregation and achieved the associated waste management cost reduction. IMPACT: A midwifery-led initiative to address waste production and segregation on a maternity ward had a positive impact on waste segregation practices and associated waste management costs. The existence of change champions along with in-service sessions, posters and newsletters to raise awareness of correct waste segregation resulted in a 71% reduction of incorrect items being placed in clinical waste bins. Challenges such as COVID-19 pressures and workload made it difficult for midwives to engage in waste management education and effective waste segregation. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: Implementing clinician-led waste management interventions across hospital wards while addressing workload issues are likely to have significant cost benefits for organisations and minimise the environmental impacts of healthcare settings.

Hand hygiene and biomedical waste management among medical students: a quasi-experimental study evaluating two training methods.

BACKGROUND: Several studies revealed that medical students have low performance levels of hand hygiene (HH) and biomedical waste management (BMWM). However, there have been limited interventions directed at young students targeting HH and BMWM enhancement. Given these data, we aimed at assessing HH and BMWM among medical students after two training methods. METHODS: We performed a quasi-experimental study from September 2021 to May 2022, which included fifth-year medical students enrolled in the faculty of Medicine of Monastir (Tunisia). We relied on a conventional training based on presentations and simulations guided by the teacher and a student-centred training method based on courses and simulated exercises prepared by students. We used the WHO HH Knowledge Questionnaire and the "BMWM audit" validated by The Nosocomial Infection Control Committee in France. RESULTS: A total of 203 medical students were included (105 in the control group and 98 in the experimental group) with a mean age of 23 ± 0.7 years. Regarding HH, we found a statistically significant increase in post-test scores for both training methods. A higher post-test mean score was noted for student-centred method (14.1 ± 1.9 vs. 13.9 ± 2.3). The overall improvement in good HH knowledge rates was greater after student-centred method compared to conventional training (40.5% vs. 25%). Concerning infectious waste, mean scores were higher after student-centred learning in all hazardous waste management steps (25 ± 3.3 vs. 23.6 ± 5.5). RESULTS: Coupling student-centred teaching and continuous supervision could improve HH and BMWM knowledge and practices among medical students.

Co-pyrolysis of medical protective clothing and oil palm wastes for biofuel: Experimental, techno-economic, and environmental analyses.

The ongoing global pandemic of COVID-19 has devastatingly influenced the environment, society, and economy around the world. Numerous medical resources are used to inhibit the infectious transmission of the virus, resulting in massive medical waste. This study proposes a sustainable and environment-friendly method to convert hazardous medical waste into valuable fuel products through pyrolysis. Medical protective clothing (MPC), a typical medical waste from COVID-19, was utilized for co-pyrolysis with oil palm wastes (OPWs). The utilization of MPC improved the bio-oil properties in OPWs pyrolysis. The addition of catalysts further ameliorated the bio-oil quality. HZSM-5 was more effective in producing hydrocarbons in bio-oil, and the relevant reaction pathway was proposed. Meanwhile, a project was simulated to co-produce bio-oil and electricity from the co-pyrolysis of OPWs and MPC from application perspectives. The techno-economic analysis indicated that the project was economically feasible, and the payback period was 6.30-8.75 years. Moreover, it was also environmentally benign as its global warming potential varied from -211.13 to -90.76 kg CO2-eq/t. Therefore, converting MPC and OPWs into biofuel and electricity through co-pyrolysis is a green, economic, and sustainable method that can decrease waste, produce valuable fuel products, and achieve remarkable economic and environmental benefits.

Adsorption Capacity and Desorption Efficiency of Activated Carbon for Odors from Medical Waste.

Five types of odor-emitting exhaust gases from medical waste were selected, and their adsorption capacity and desorption efficiency were investigated using activated carbon. The selected gases included polar gases (hydrogen sulfide (H2S) and ammonia (NH3)) and non-polar gases (acetaldehyde (AA), methyl mercaptan (MM), and trimethylamine (TMA))). Commercial activated carbon with a specific surface area of 2276 m2/g was used as the adsorbent. For the removal of odor from medical waste, we investigated: (1) the effective adsorption capacity of a single gas (<1 ppm), (2) the effect of the adsorbed NH3 gas concentration and flow rate, and (3) the desorption rate using NH3 gas. The values of the effective adsorption capacity of the single gas were in the following order: H2S < NH3 < AA < MM < TMA, at 0.2, 4.2, 6.3, 6.6, and 35.7 mg/g, respectively. The results indicate that polar gases have a lower effective adsorption capacity than that of non-polar gases, and that the size of the gas molecules and effective adsorption capacity exhibit a proportional relationship. The effective adsorption performance of NH3 gas showed an increasing trend with NH3 concentration. Therefore, securing optimal conditions for adsorption/desorption is imperative for the highly efficient removal of odor from medical waste.

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.

Two-phase COVID-19 medical waste transport optimisation considering sustainability and infection probability.

A safe and effective medical waste transport network is beneficial to control the COVID-19 pandemic and at least decelerate the spread of novel coronavirus. Seldom studies concentrated on a two-phase COVID-19 medical waste transport in the presence of multi-type vehicle selection, sustainability, and infection probability, which is the focus of this paper. This paper aims to identify the priority of sustainable objectives and observe the impacts of multi-phase and infection probability on the results. Thus, such a problem is formulated as a mixed-integer programming model to minimise total potential infection risks, minimise total environmental risks, and maximise total economic benefits. Then, a hybrid solution strategy is designed, incorporating a lexicographic optimisation approach and a linear weighted sum method. A real-world case study from Chongqing is used to illustrate this methodology. Results indicate that the solution strategy guides a good COVID-19 medical waste transport scheme within 1 min. The priority of sustainable objectives is society, economy, and environment in the first and second phases because the total Gap of case No.35 is 3.20%. A decentralised decision mode is preferred to design a COVID-19 medical waste transport network at the province level. Whatever the infection probability is, infection risk is the most critical concern in the COVID-19 medical waste clean-up activities. Environmental and economic sustainability performance also should be considered when infection probability is more than a certain threshold.