Disposal Of Clinical Waste Research Articles

Perceptions and decision-making of dental professionals to adopting sustainable waste management behaviour: a Theory of Planned Behaviour analysis.

Background High carbon emissions associated with clinical waste disposal in dentistry pose an environmental and public health concern. Current NHS guidelines do not mandate sustainable waste management resulting in recyclable dental waste being incinerated. In the absence of such policies, decision to implement sustainable waste management practices falls upon dental professionals who rely on their own knowledge and beliefs about the environmental impact of dentistry. Literature exploring barriers to sustainable waste management by dental professionals require further insight on dental professionals' decision-making processes. Therefore, this study uses a behavioural decision-making model - the Theory of Planned Behaviour (TPB) - to explore sustainable waste segregation behaviour of dental professionals based on their attitudes and beliefs about sustainable dentistry and climate change.Methods Fifteen semi-structured interviews were conducted with dental professionals between October and November 2022 in dental practices in Fife, Scotland. Interviews were analysed using Braun and Clarke's reflexive thematic data analysis.Findings Following thematic analysis, eight themes were identified around the participants' attitudes, perceived subjective norms and perceived behavioural control, pointing at the way knowledge gaps and lack of awareness were often linked with attitudes which are associated with low intention to execute sustainable waste management.Conclusions TPB offers a useful framework to understand waste segregation behaviour of dental professionals. Further studies are required to further establish sustainable waste management behaviour.

Perceived Environmental Health Effects of Clinical Waste Disposal in Ahoada Local Government Area of Rivers State Nigeria

The study examined the perceived health effects of clinical waste disposal in Adoada East Local Government Area of Rivers State, Nigeria on people. Purposive and random sampling techniques were employed for the collection of the data set comprising a sample size of 184 respondents selected from health/medical personnel, cleaners in health facilities, waste handlers, nurses, midwives, and doctors through structured questionnaires including basic statistical techniques using a criterion of 2.50 on the 4-point Likert scale. The result of the various analyses conducted revealed that the major types of waste generated from hospitals and medical facilities are needles, syringes scalpels, blades, and lancets, including placentas and other human tissues as well as papers, plastics, and glasses. The analysis from the returned questionnaires further indicates that the main methods of clinical waste disposal and treatment of used medical instruments/tools (autoclaving) include open burning of clinical wastes such as paper, plastic, cans, etc. The implications of the observed poor and inappropriate disposal of clinical waste in the study area include a high risk of infection among health/medical personnel and the spread of communicable diseases in the neighborhood. Given the depth of the analysis and the results generated, the study recommends the deployment of more qualified medical and para-medical personnel to the local government health facilities and the provision of modern equipment to tackle the rising cases of infectious diseases and community health associated with improper clinical waste disposal in the study area.

Infection prevention and control policy implementation for CPE: a cross-sectional national survey of healthcare workers reveals knowledge gaps and suboptimal practices

In 2017, Ireland pioneered a unique response to the worsening epidemiology of carbapenemase-producing Enterobacterales (CPE), declaring a national public health emergency. Subsequently, CPE mitigation guidelines and policies were implemented in acute hospitals, focused on patient screening and outbreak management, often by healthcare workers (HCWs) with limited background in infection prevention and control (IPC). CPE risks from sinks and drains remain inadequately controlled. To compare CPE awareness, perceptions of the role of the environment in CPE transmission, and disposal practices of liquid waste from clinical handwashing sinks between IPC HCWs and non-IPC HCWs in Ireland. Between December 2022 and March 2023, HCWs employed in acute hospitals in Ireland between 2017 and 2022 were invited to participate anonymously in a 30-question digital survey. Responses (N=283) were received across several clinical disciplines. In total, 21.6% of respondents were working or had previously worked in IPC roles, 84.1% of whom reported no IPC-related learning needs. In comparison with non-IPC HCWs, more IPC HCWs perceived a risk of pathogen transmission from clean water plumbing (68.9% vs 39.2%; P<0.001) and waste/drainage plumbing (81.2% vs 43.7%; P<0.001). Among nursing and medical staff, only 5.6% of IPC HCWs used clinical handwashing sinks for disposal of liquid waste, compared with 60% of non-IPC HCWs (P<0.001). In comparison with non-IPC HCWs, a greater proportion of IPC HCWs reported that they had witnessed colleagues routinely discarding liquid waste (including nutritional products, antimicrobials and patient body fluids) via clinical handwashing sinks (88.9% vs 77.9%) CONCLUSIONS: Although there is general awareness of the role of the built environment in pathogen transmission, including CPE, familiarity with sink/water-related transmission is greater among IPC HCWs. There may be opportunities to improve disposal practices for liquid waste through education targeting non-IPC HCWs.

Association of antibiotics and heavy metal arsenic to horizontal gene transfer from multidrug-resistant clinical strains to antibiotic-sensitive environmental strains.

The emergence of multidrug-resistant bacteria is currently posing a significant threat to global public health. By testing for resistance to different antibiotic classes, we discovered that the majority of clinical bacteria are multidrug-resistant. These clinical multidrug-resistant species have antibiotic resistance genes on their plasmids that can be horizontally transferred to various antibiotic susceptible environmental bacterial species, resulting in antibiotic-resistant transconjugates. Furthermore, we discovered that the presence of an optimal concentration of antibiotics or heavy metal (arsenic) facilitates horizontal gene transfer through the formation of transconjugants. Notably, the addition of a conjugation inhibitor (2-hexadecynoic acid, a synthetic fatty acid) completely blocked the formation of antibiotic or arsenic-induced transconjugants. We discovered a high level of arsenic in water from the Shukratal region, Uttarakhand, India, which corresponded to a high serum level of arsenic in clinically infected individuals from the Shukratal region compared to other locations in Uttarakhand. Importantly, bacterial strains isolated from infected people who drink water from the Shukratal region with high arsenic levels were found to be more antibiotic-resistant than strains isolated from other sites. We discovered that bacterial strains isolated from individuals with high serum arsenic levels are significantly more resistant to antibiotics than individuals with low serum arsenic levels within the Shurkratal. This research sheds light on imminent threats to global health in which improper clinical, industrial, and other waste disposal, increased antibiotic concentrations in the environment, and increased human interference can easily transform commensal and pathogenic bacteria found in environmental niches into life-threatening multidrug-resistant superbugs.

Operating room waste management: A case study of primary hip operations at a leading National Health Service hospital in the United Kingdom

This research examines current waste management within an operating room at a large United Kingdom National Health Service (NHS) hospital. The study measured the volume and type of waste produced for primary hip operations (PHOs) and estimated the total waste produced across the United Kingdom by the procedure. Three PHOs were audited to measure and compare the waste volumes generated. The average volume of waste per surgical procedure was 10.9kg, consisting of clinical (84.4%), recyclable (12.8%) and bio-bin (2.8%) waste. This research also found that single-use devices contribute significantly to operating room waste. In addition, it was estimated that there is a missed opportunity to reduce clinical waste volume in each procedure, where approximately 15% of clinical waste disposal consisted of visibly clean recyclable waste material, including cardboard and plastics. It was estimated that in the NHS approximately 1043 tonnes of waste is produced annually by PHOs alone. A significant volume of this waste could be prevented through improved recycling and reduced use of single-use devices.

Effect of medical education on the knowledge, attitude and compliance regarding infection control measures among dental students in Makkah

Background: Infectious diseases are the major causes of morbidity and mortality related to clinical, diagnostic and therapeutic procedures. Dentists should apply the guidelines for infection control during practice to prevent cross infection. This study aimed to assess the effect of medical education on the knowledge, attitudes and compliance among dental students regarding infection control measures at the dental teaching hospital faculty, Umm Al-Qura University (UQU), Makkah, Saudi Arabia. Methods: A cross-sectional comparative study was performed to assess the knowledge, attitude and compliance towards infection control using a structured questionnaire. All students attending dental clinics in the 4th, 5th and 6th grades (n = 186), 94 males and 92 females participated in this study. Results: Most dental undergraduate students have a knowledge of infection control in dental clinics including sterilization (83%), personal protective equipment (87.1%), proper hand hygiene (86.3%), vaccination (97.9%) and safe disposal of clinical waste (83.9%). More than 90% of UQU dental students were tested for Hepatitis B virus (HBV), performed wrap and disinfection of the dental unit before treating patients and wore personal protective equipment (PPE). The 6th grade dental students have superior knowledge compared to 4th and 5th grade dental students. The attitude and compliance to infection control guidelines within each grade were comparable. However, a between grade comparison showed that the 4th grade students had a better attitude and compliance.

Personal protective equipment preparedness in Asia-Pacific intensive care units during the coronavirus disease 2019 pandemic: A multinational survey

BackgroundThere has been a surge in coronavirus disease 2019 admissions to intensive care units (ICUs) in Asia-Pacific countries. Because ICU healthcare workers are exposed to aerosol-generating procedures, ensuring optimal personal protective equipment (PPE) preparedness is important. ObjectiveThe aim of the study was to evaluate PPE preparedness across ICUs in six Asia-Pacific countries during the initial phase of the coronavirus disease 2019 pandemic, which is defined by the World Health Organization as guideline adherence, training healthcare workers, procuring stocks, and responding appropriately to suspected cases. MethodsA cross-sectional Web-based survey was circulated to 633 level II/III ICUs of Australia, New Zealand (NZ), Singapore, Hong Kong (HK), India, and the Philippines. FindingsTwo hundred sixty-three intensivists responded, representing 231 individual ICUs eligible for analysis. Response rates were 68–100% in all countries except India, where it was 24%. Ninety-seven percent of ICUs either conformed to or exceeded World Health Organization recommendations for PPE practice. Fifty-nine percent ICUs used airborne precautions irrespective of aerosol generation procedures. There were variations in negative-pressure room use (highest in HK/Singapore), training (best in NZ), and PPE stock awareness (best in HK/Singapore/NZ). High-flow nasal oxygenation and noninvasive ventilation were not options in most HK (66.7% and 83.3%, respectively) and Singapore ICUs (50% and 80%, respectively), but were considered in other countries to a greater extent. Thirty-eight percent ICUs reported not having specialised airway teams. Showering and “buddy systems” were underused. Clinical waste disposal training was suboptimal (38%). ConclusionsMany ICUs in the Asia-Pacific reported suboptimal PPE preparedness in several domains, particularly related to PPE training, practice, and stock awareness, which requires remediation. Adoption of low-cost approaches such as buddy systems should be encouraged. The complete avoidance of high-flow nasal oxygenation reported by several intensivists needs reconsideration. Consideration must be given to standardise PPE guidelines to minimise practice variations. Urgent research to evaluate PPE preparedness and severe acute respiratory syndrome coronavirus 2 transmission is required.

1695P Risk assessment of admission procedures for cancer patients during the convalescence of COVID-19

Through great efforts, the outbreak of 2019 novel corona virus disease (COVID-19) has been slowing down in Wuhan. This study was to assess the potential errors of established admission procedures from a tertiary cancer center. A multidisciplinary team of eight frontline nurses and oncologists would conduct a failure mode and effects analysis (FMEA) to our established procedures. The FMEA consisted of 4 main steps, Including a detailed review of the on-going admission processes and the drawing of the corresponding flow chart, followed by repeated discussions of the possible errors among those processes, and then evaluation of the occurrence (O), detectability (D), and severity of impact (S) of each failure mode according to a scoring criteria (a five-point scale). Finally, the risk of errors were determined through a calculation of risk priority number (RPN=O*D*S). From March 24, 2020 to May 14, 2020, based on the established procedures, our center has screened 1,214 cancer patients in the oncology outpatient department and subsequent buffer wards. No nosocomial infection (among doctors or patients, or between patients and doctors) occurred. On the scale of RPN from high to low, ten high-risk steps were identified by FMEA, involving a failure of scheduled screening for particularly vulnerable populations, the failure of hand hygiene in outpatient and buffer wards, and the incorrect disposal of clinical waste by cleaning service staff. In addition, the psychological burden to cancer patients might increase the risk of buffer ward management failure. Self-review and continuous improvement for established procedures can minimized underlying mistakes. Increasing the approaches to treatment appointments, reasonably optimizing the working during for outpatient physicians, strengthening the awareness of hand hygiene (both physicians and patients), and setting up oncological psychological counseling groups will likely improve the potential error steps.

Gender Differences in the Management of Hazardous Biological Material in Medical Teaching Laboratories

Hazardous waste of medical or research laboratory origin is a potential source of contamination to the environment. Untreated waste could contribute to the prevalence of various antibiotic-resistant human opportunistic pathogens. Efficient and proper handling and disposal of biological and clinical waste increases the biosafety of these facilities and reduce any potential threat to the environment. The aim of this study was to determine any gender difference in the management of hazardous biological materials among workers in medical teaching laboratories. The study included 75 participants, 56% of whom were females and 44% were males. A questionnaire including 4 sections was distributed among the participants. The results of the study found no gender difference in the participant's knowledge of the international biohazard and safety symbols and compliance with the recommended hazardous waste disposal procedures. In contrast, incident reporting was significantly higher among males (p < 0.05). Extensive training programs and regular review of biosafety policy in teaching medical laboratories are required.

Zoonosis and veterinary waste disposal in rural practice

The objectives of this study were to estimate: (a) the frequency of zoonoses in large animal veterinarians from rural areas of the province of Buenos Aires, Argentina, and (b) to describe the use and disposal of personal protective equipment (PPE) and selective veterinary clinical waste. A cross-sectional study was carried out on large animal veterinary practitioners in the Province of Buenos Aires (n=106). One third (29.2%) of them had been diagnosed with a zoonosis by laboratory-methods, being brucellosis the most frequent (22.6%). The more years passed since their graduation, the greater the chances of becoming ill (p<0.001). Gloves were the most adopted PPE; however, other elements had little or no use at all. Older and experienced professionals used PPE less frequently than young inexperienced practitioners. Some PPE was frequently reused and the final disposal of veterinary waste was often inappropriate. A change in behavior is an urgent need to preserve not only the veterinarians’ health but also their families’ wellbeing and to ensure proper disposal of potentially hazardous waste.

Attitudes of Biological Waste Management among a Sample of Academic Personnel Working in Baghdad

Biosafety and biosecurity of academic and teaching facilities is maintained when the appropriate guidelines for the safe management of biological waste is implemented. Biological waste is a potential source of infections and occupational hazards. Previous studies assessing the awareness of some academic and technical laboratory staff working in Iraq has identifed gaps in the awareness of the recommended procedures associated with biological and clinical waste disposal. This study was aimed to determine the awareness and attitude of laboratory staff towards biological waste practices and management policy. A closed end questionnaire was distributed among a number of laboratory staff working in universities in Baghdad and the results were analyzed. Although waste disposal procedures were followed at some degree, but a wider implementation of appropriate waste disposal procedures is necessary. No satisfactory segregation or classifcation of biological waste was noticed. The results of this study identifed the need for each laboratory to have its own code of practice and policy for the management of biological and clinical waste generated in the laboratory. The various biological waste such as clinical samples, tips, tubes, etc, should be classifed and an appropriate waste disposal procedure should be outlined for each category.

A percepção profissional sobre o gerenciamento dos resíduos de serviços de saúde em unidades básicas e ambulatórios de saúde em um município da Região Metropolitana de Sorocaba, SP, Brasil

In 2004, the Brazilian Health Regulatory Agency (ANVISA - National Health Surveillance Agency), published Resolution 306 of the Collegiate Board of Directors (RDC), which established the criteria for clinical waste disposal (RSS) management, by informing the kind of waste and their segregation, packaging, storage, transport and destination. The goal of this investigation is to determine the professional’s perception in the management of clinical waste in the ambulatory care centers in a municipality of the Metropolitan Region of Sorocaba, SP, Brazil. Method: individual qualitative interviews were used to collect data. As seen in the results, most of the professionals do not have the technical knowledge required for managing RSS. In addition, they indicated a lack of training in this area, which limits the involvement of health professionals with environmental matters. It was also evident that health professionals place the procedures directly associated with patient care as their priority, putting aside crucial matters connected to the development of preventative practices related to environmental preservation and the promotion of the population’s quality of life.

ISOLATION OF EXTENDED-SPECTRUM BETA-LACTAMASES PRODUCING STRAINS ON EFFLUENT OF STATE HOSPITAL FROM BOA VISTA-RR

The extended spectrum beta-lactamase (ESBL) producing bacteria are widespread in hospital environments. The incorrect disposal of clinical waste in hospital effluents, allows them to present high concentrations of bacteria with antimicrobial resistance profiles that present an environmental risk to the extent that they allow the dissemination. This research covers the characterization of the presence of multi-resistant antimicrobial bacteria in strains isolated from hospital effluents, whose associated risks include the spread of pathogenic microorganisms in the environment. To complete this research, the proposed objectives were: characterization of the hospital effluent strains generated by the General Hospital of Roraima (GHR) and research of the resistance genes responsible for ESBL coding and hydrolysis to the antimicrobials of the class of cephalosporins, penicillins and monobactams. Samples were collected from the hospital septic tank from June 2014 to June 2016, submitted to molecular identification for the detection of genes through the polymerase chain reaction (PCR). The results showed the presence of ESBL in all of the collected tanks and a multi-resistance profile. ESBL genes were identified on isolated frequencies and they were combined. The results indicated the widespread dissemination of the ESBL genes in the GHR effluent.

The Gold in Garbage: Implementing a Waste Segregation and Recycling Initiative

Generally, ORs produce approximately one-fifth to one-third of all waste in a hospital. Before our quality improvement project was performed in our tertiary care facility, all OR waste was disposed of as clinical waste. Disposal of clinical waste is more costly than disposal of general waste. Therefore, accurately segregating waste can have significant financial incentives. Our quality improvement project involved the implementation of processes that segregated general waste in the OR from clinical waste and translated to an almost 60% reduction of waste disposal costs for OR waste. Further, we implemented a recycling program that reclaimed a portion of the general waste. In total, our efforts reduced the amount of clinical waste produced by the OR by 82%, and the amount of total OR waste was reduced by more than 50%.

Hijama therapy (wet cupping) – its potential use to complement British healthcare in practice, understanding, evidence and regulation

Wet cupping was used in the nineteenth century for treatment of patients in the United Kingdom (UK) by a few experienced practitioners. Revival Hijama use by practitioners in the UK in recent years has been observed as well as interest from the public, with developments of specific certified training programmes, established businesses providing tailored Hijama therapy Clinical Waste disposal services, provisions of insurance cover, involvement of medical professionals and membership with the General Regulatory Council for Complementary Therapies (GRCCT). However, there has also been noted that there is not much in the way of guidance or regulation. Therefore, we would like to initiate some communication and understanding of Hijama (wet cupping) to benefit medical professionals, discussing recent research undertaken as a basis for potentially more in the future (evidence-based practice), in the likely event that a patient might request to be referred for this therapy during a consultation.

Supercritical Carbon Dioxide as Non-Thermal Alternative Technology for Safe Handling of Clinical Wastes

The expansions of communities and cities over the last two decades have led to the increase of the number of health care facilities, and thus, clinical wastes are generated in significant amounts. Clinical wastes are a potential source for many pathogens such as viruses, parasites, fungi and bacteria. Therefore, clinical wastes should be treated before disposal into the environment. The incineration is the most common technology applied for the treatment process. However, the negative effects of incineration on humans and the environment have led scientists to define alternative technologies for the safe disposal of clinical waste. Numerous treatment technologies have been investigated as an alternative for incineration, such as autoclave and microwave. These technologies generally depend on temperature while the recent direction is to use a non-thermal sterilization processes. SC-CO2 is one of the non-thermal sterilization technologies, which depends on pressure and low temperature. Currently, SC-CO2 has been extensively used for the inactivation of microorganisms in food and pharmaceutical industries. However, the application of SC-CO2 in treating clinical wastes has been on a rise. Studies conducted on the inactivation of fungi in food, normal saline and growth media indicate that SC-CO2 has the ability to inactivate these organisms. In clinical wastes, SC-CO2 has been found to be effective in the inactivation of pathogenic bacteria. Therefore, this review paper focuses on the potential of using SC-CO2 as alternative technology for inactivating fungi in clinical wastes.

Adherence to Healthcare Waste Management Guidelines among Nurses and Waste Handlers in Thika Sub-county- Kenya.

Despite the set guidelines on Healthcare Waste Management in Kenya, mixing of different categories of waste, crude dumping and poor incineration are still a common phenomenon in public health facilities in Thika Subcounty, Kenya. Thika Subcounty generates 560 Kilograms of healthcare waste daily, which is risk to the many patients (admission rate of 26%). This may pose a potential environmental risk and be a source of disease diffusion. This research explored the adherence to healthcare waste management waste guidelines in health care facilities among the nurses and waste handlers. This was a cross sectional survey in which mixed methods were applied. A census and proportionate random sampling method were used. Quantitative data was analyzed using Statistical Package for Social Science (SPSS) version 20.0, while qualitative data was analyzed manually into themes. Full adherence to the seven waste disposal guidelines was low (16.3%). Knowledge on waste segregation, waste separation then disposal and means of transports were statistically significant in relation to adherence. The type of incinerator and burning status, protection maintenance and supply of adequate waste bins were also important to adherence level. Adherence level was low (16.3%,) and insignificantly different among nurses and waste handlers. From this finding, compliance remains a key challenge. Strategies targeted at contextualizing waste regulations and guidelines into local settings are necessary and important. Policy makers may design and implement standard incinerators across all the health facilities. This study is not exhaustive; therefore, it is necessary to carry out a study linking poor treatment and disposal of clinical waste to purported health outcomes in Kenya.

Nursing students' attitudes towards sustainability and health care.

Aim To evaluate attitudes towards embedding sustainability and climate change in nursing curricula among nursing students, some of whom had participated in a sustainability and health skills session, and determine whether the session could improve knowledge of sustainability. Methods Three months after the sustainability session, students who had participated along with a sample of students who had not, completed a Sustainability Attitudes in Nursing Survey questionnaire. This investigated attitudes towards climate change and sustainability in nursing curricula and the costs of clinical and domestic waste disposal. Results Nursing students were positive about sustainability and climate change and its inclusion in the curriculum, irrespective of their participation in the sustainability scenario session. Participants in the sustainability session were more likely to identify correctly the cost of clinical waste disposal in the NHS. Conclusion The sustainability and health skills session has the potential to improve nursing students' knowledge of the cost of clinical waste disposal.

A Case Study Evaluation of the Training Gaps among Palliative Caregivers in Botswana Community Home Based Care Programs (CHBC)

The aim of the present research is to evaluate the training gaps and challenges within the Botswana community home based care programs exemplified by an empirical case study. The study used qualitative paradigm; was exploratory in nature and used case study design; and entailed interviewing 82 palliative primary caregivers in 10 focus groups and five CHBC nurses on one-to-one in-depth interviews. An interview guide served as a data collection instrument for both the focus groups and the interviews. Findings indicated an array of training gaps and challenges such as: lack of a caregiver training arrangement in the CHBC program; inadequate training of the caregivers; caregivers' inadequate skills in handling and disposal of clinical waste; complaints of primary caregivers being discriminated in training in favour of for community caregivers. The CHBC program needs: a comprehensive caregiver training to increase caregivers' understanding of the care giving field generally; training of caregivers on gender mainstreaming, self-care, management of clinical waste, and in income generating activities. Balancing training opportunities between the palliative primary caregivers and community palliative caregivers (volunteers) has been found critical.

Impact of a linerless, reusable, clinical wastebin system on costs, waste volumes and infection risk in an Australian acute-care hospital

Abstract Introduction Regular audits of clinical waste (CW) disposal systems and examination of new technologies can lead to cost and waste reductions, and lowering of infection potential. Sydney Adventist hospital, a 360-bed acute-care private facility, noted that their 240L, clinical waste (CW) bin system posed issues with infection risk, staff injury risk, aesthetics, logistics, space and cost and evaluated a new, linerless, reusable bin system. Methods A facility-wide audit was conducted of the current 240L bin system before a three ward, 3-month staff evaluation of the new, 64L, linerless, reusable bin system (Clinismart, SteriHealth Ltd, Melbourne, Vic., Australia). Clinical waste volume and mass were compared between systems over a 30-month period as were contractor costs, labour, space requirements and general waste (GW) mass. Staff opinion was sought via a 10-point questionnaire, and infection and injury risks audited. Results Inpatient workloads remained static over the study. Staff evaluations showed a strong preference for the new system which was rolled-out to all wards in the facility. Significant decreases were noted in CW mass (53.2% less), CW volume (65.2% less), CW disposal costs (30.9% less) and labour (69.2% less), and the new system was found to be more space-efficient and logistically superior. Waste segregation was markedly enhanced. Infection potential and injury risks noted with the 240L system were eliminated. Conclusion The study found that the use of a smaller, 64L, linerless, reusable, hospital wastebin system, through its design and operation, has the potential to reduce clinical waste volumes, increase labour efficiencies, decrease costs and minimise infection potential and sharps injury risk, all of which improve the quality of health care.