Handling Of Medical Waste Research Articles

Disposal of Endoscopic Accessories After Use: Do We Know and Do We Care?

Significant amounts of medical waste are generated in endoscopy units. Improper disposal has significant health, cost, and environmental implications. The aim of this study was to better understand the appropriateness of handling of medical waste in the endoscopy unit. This is a validated survey completed online and in person by endoscopy staff and gastroenterologists. Main outcome measurements include the method of disposal of endoscopic accessories (snares, dilating balloons, endoscopic retrograde cholangiopancreatography wires, and sphincterotomes) and nasogastric tubes and whether or not in the appropriate disposal bin (i.e., in sharps container, red bags, or regular trash). The appropriateness of the method of disposal was determined per Occupational Safety and Health Administration guidelines. Respondents included 783 endoscopy staff members and 352 gastroenterologists. Fifty-eight percent of endoscopy staff members and 65% of gastroenterologists handled simple endoscopic accessories as regulated medical waste instead of regular trash. Furthermore, 27% of respondents discarded endoscopic accessories as sharps, although they are not considered sharps. Nearly one third of respondents discarded nasogastric tubes and other endoscopic accessories differently, even though both would have same degree of contamination. Only 7 respondents (0.6%) understood disposal costs. All but 23 respondents (2%) felt that medical personnel should be better informed about medical waste. Most medical waste from endoscopy laboratories is handled inappropriately. Endoscopy staff and gastroenterologists' understanding of recommended disposal methods for endoscopic accessories is poor. The data have major financial and environmental implications.

PENANGANAN LIMBAH MEDIS DAN PERILAKU PETUGAS CLEANING SERVICE DI RSUD Dr. SOETOMO SURABAYA TAHUN 2016

Health workers who handle medical waste are at risk of the diseases faced because of germs from the skin infections, anthrax, meningitis, dengue, hepatitis A, Hepatitis B and C. The bacteria present in the blood are transmitted through blood. The highest risk of being infected by these diseases is when impaled by sharp or pointed object of the waste because it can damage the skin. The purpose of this study was to determine the behavior of CS officers (Cleaning Service) and the handling of medical waste in Dr. Soetomo hospital. This is a descriptive research with cross sectional approach. The collection of data was carried out through observation and interviews. The sample was 75 CS officers. Data were analyzed descriptively with table analysis.The results showed that Cleaning Services’ level of knowledge at Dr. Soetomo Hospital on handling medical waste with "Good" criteria was 90.8%. The CS attitude with "good" criteria was 88% and poor was 5.3%. CS’s behavior with "Good" criteria was 92% and "poor" was 6.7%. It can be concluded that of 75 Cleaning Service at Hospital Dr. Soetomo, most of them were well behaved and only a small proportion have poor behavior. The handling of medical waste in Dr. Soetomo hospital has been qualified in accordance with Kepmenkes No 1204 of 2004. It is recommended to conduct counseling on the importance of the use of personal protective equipment and the dangers of medical waste. Warning is also needed to officers whose work is not according to the rules. Keywords: CS Behavior, handling of medical waste

Effect evaluation of group-generalization first aid modeling drilling in first aid skills training for nurses

Objective To explore the group-generalization first aid modeling drilling and its effects on training of first aid skills for nurses. Methods Training scheme of group-generalization first aid modeling drilling was designed. A total of 240 nurses with 2 to 5 years of service were selected to be trained in first-aid skills for 8 months. We compared the knowledge of first aid theory, manipulative skill of first-aid, the score of group-generalization first aid modeling drilling before and after training. The score of group-generalization first aid modeling drilling included 65% for personal operation and 35% for comprehensive evaluation through group (ability to judge the change of the condition, emergency response capability, teamwork ability, communication ability, ability of writing nursing records, accident during rescue process, other abilities including medical waste handling and so on). We also compared the score of group comprehensive evaluation, the time of simulation drilling, the problem frequencies before and after group-generalization first aid modeling drilling. T test and chi square test were used for statistical analysis according to the data type. Results After training, scores of knowledge of first aid theory, manipulative skill of first-aid and personal of group-generalization first aid modeling drilling were (83.20±4.80), (81.96±4.89) and (86.95±6.06) significantly higher than those before training [(78.10±8.46), (80.20±7.72), (76.37±10.79)] with statistically significant differences (t=8.84, 2.59, 9.61; P<0.05). The score of comprehensive evaluation through group of group-generalization first aid modeling drilling was (16.68±2.51) before training compared (22.06±2.81) after training with a significant difference (t=13.22, P<0.01). The time of simulation drilling decreased from 11 minutes to 7 minutes. There was a significant decrease in the incidence of problems with significant differences (P<0.05). Conclusions The group-generalization first aid modeling drilling effectively improves the knowledge level of first aid theory and manipulative skill of first-aid and is helpful to comprehensively enhance the ability of comprehensive first aid so as to improve the quality of emergency treatment and nursing. Key words: First aid; Train; Junior nurses; Ability of comprehensive emergency; Group-generalization first aid modeling drilling

Focus on the legislative approach to short half life radioactive hospital waste releasing

PurposeWe propose to summarize the advancements introduced by the new Directive 2013/59/Euratom concerning the concept of clearance, for which the radioactive medical waste represents a typical candidate. We also intend to spotlight disputable points in the regulatory scheme in force in Italy, as well to make a contribution to evaluate whether the practice of patients' urine storing, stated by it, can be regarded to be proper. MethodsWith directing our interest to radionuclides used in Nuclear Medicine, we first present an overview of how the clearance concept, and that of exemption closely related to it, have been developed from the previous Directive 96/29 to the new one; then we describe the implementation of these concepts in the Italian legislation. Subsequently we estimate the exposure due both to keeping the effluent on site and to direct discharging it to the environment. ResultsIn line with a well established international consensus, the Directive 2013/59 drives simple and harmonized regulation of clearance. On the contrary, some complexity and lack of consistency can be found in the framework of the national legislation affecting the radioactive medical waste handling. In addition the practice of excreta storing is disputed not to be really beneficial. ConclusionThe opportunity should be taken to make the whole system of these requirements simpler and more consistent and effective when it is revised to transpose the new Directive.

Aspects of Medical Waste Management in County Hospital

This paper aims to highlight how the county hospital manages to monitor the amount of medical waste produced. For three semesters the waste management activity has been monitored and analyzed. The regression analysis reveals that some medical waste depends on patients’ number with highly significance. The paper also reveals the most common risks generated by improper handling and collection of medical waste.

Rapid assessment of occupational health and safety measures for personnel handling healthcare waste in the Gaza Strip, Palestine

Proper healthcare waste (HCW) management practices and precautions are crucial to avoid occupational and environmental health problems amongst healthcare workers. This study aims to assess the occupational health and safety of healthcare workers involved in medical waste handling in two hospitals in the Gaza Strip, Palestine. This study was cross–sectional in design, and a simple random sampling technique was used to distribute a semi–structured questionnaire among 164 healthcare workers at two hospitals, one public and one private, in the Gaza Strip. The results show that occupational health and safety amongst hospital healthcare workers is low. This may be attributable to poor implementation of protective measures and a deficiency in implementing training courses about healthcare waste management and associated hazards. The authors recommend that the Ministry of Health and healthcare institutions increase their focus on the design and implementation of policies for best practice management and disposal of healthcare waste in Palestine.

An Ecological Perspective on Medical Care: Environmental, Occupational, and Public Health Impacts of Medical Supply and Pharmaceutical Chains

Healthcare organizations are increasingly examining the impacts of their facilities and operations on the natural environment, their workers, and the broader community, but the ecological impacts of specific healthcare services provided within these institutions have not been assessed. This paper provides a qualitative assessment of healthcare practices that takes into account the life-cycle impacts of a variety of materials used in typical medical care. We conducted an ethnographic study of three medical inpatient units: a conventional cancer ward, palliative care unit, and a hospice center. Participant observations (73 participants) of healthcare and support staff including physicians, nurses, housekeepers, and administrators were made to inventory materials and document practices used in patient care. Semi-structured interviews provided insight into common practices. We identified three major domains that highlight the cumulative environmental, occupational health, and public health impacts of medical supplies and pharmaceuticals used at our research sites: (1) medical supply procurement; (2) generation, handling, and disposal of medical waste; and (3) pharmaceutical handling and disposal. Impacts discovered through ethnographic inquiry included occupational exposures to chemotherapy and infectious waste, and public health exposures to pharmaceutical waste. This study provides new insight into the environmental, occupational, and public health impacts resulting from medical practices. In many cases, the lack of clear guidance and regulations regarding environmental impacts contributed to elevated harms to the natural environment, workers, and the broader community.

MEDICAL WASTES MANAGEMENT A POLICY REVIEW

Abstract&#x0D; &#x0D; Since so many mishandling of medical waste in various places in Indonesia that has endangered our environment by the potential disease that easily can spread to our society , it is very important for all of us to address it on how to improve the medical waste management. There are area of improvement needed in our regulation, public policies disciplines and social awareness and especially the importance of proper handling of medical waste by the medical waste producers such as hospital, clinic and laboratories. This study is not intended to produce scientific theory but more focus on how to solve the problem of medical waste with the limit time and less costly manner or in the other words as a macro diagnosis of “the main causes of the problems” of medical waste management in Indonesia. This study has made clear conclusion that Indonesia has to follow the basic principle and guidelines of International standards and recommends improvement of the coordination between Ministry of Health and Ministry of Environment, toward “one roof policy”, “strong political will of top government to empower MOE and also Law No. 18, 2008 and Law No. 32, 2009 must be reviewed toward “Polluter pay the price” Policy. The government also must allocate sufficient fund to function as regulator and controlling body and increase social awareness for environmental health.&#x0D; &#x0D; Key note: Medical waste, public policy, environmental health

MEDICAL WASTES MANAGEMENT A POLICY REVIEW

&nbsp; Since so many mishandling of medical waste in various places in Indonesia that has endangered our environment by the potential disease that easily can spread to our society , it is very important for all of us to address it on how to improve the medical waste management. There are area of improvement needed in our regulation, public policies disciplines and social awareness and especially the importance of proper handling of medical waste by the medical waste producers such as hospital, clinic and laboratories. This study is not intended to produce scientific theory but more focus on how to solve the problem of medical waste with the limit time and less costly manner or in the other words as a macro diagnosis of “the main causes of the problems” of medical waste management in Indonesia. This study has made clear conclusion that Indonesia has to follow the basic principle and guidelines of International standards and recommends improvement of the coordination between Ministry of Health and Ministry of Environment, toward “one roof policy”, “strong political will of top government to empower MOE and also Law No. 18, 2008 and Law No. 32, 2009 must be reviewed toward “Polluter pay the price” Policy. The government also must allocate sufficient fund to function as regulator and controlling body and increase social awareness for environmental health. &nbsp; Key note:&nbsp;Medical waste, public policy, environmental health

Assessment of medical waste management in the main hospitals in Yemen

No previous studies about the management of medical waste have been published in Yemen. This research in 5 government and 12 private hospitals in Sana'a aimed to evaluate waste-workers' and hospital administrators' knowledge and practices regarding medical waste handling. Interviews and observations showedadministrators' knowledge and practices regarding medical waste handling. Interviews and observations showed that the waste-workers were collecting medical and nonmedical wastes together manually in all hospitals without receiving adequate training and without using proper protection equipment. There was poor awareness about medical waste risks and safe handling procedures among hospital administrators, and most hospitals did not differentiate between domestic and medical waste disposal. Budgets were not allocated for waste management purposes, which led to shortages in waste handling equipment and an absence of training programmes for staff. Poor knowledge and practices and a high rate of injuries among waste-workers were noted, together with a risk of exposure of staff and visitors to hazardous waste.

Medical waste management at the University of Port Harcourt Teaching Hospital

Background: The generation and handling of wastes from medically related procedures poses a potential health hazard to health workers and non health workers alike, and this has far reaching consequences for the public in areas where such wastes are disposed of carelessly. Aim: To investigate the medical waste management procedure at the University of Port Harcourt Teaching Hospital (UPTH) and assess the knowledge of, attitudes to and practice of waste management by staff of the Hospital. Methods: A stratified random sampling method was used for this descriptive cross sectional study, using a structured questionnaire that was pre-tested, as the instrument of data collection. The respondents were directly involved with medical waste generation, handling and disposal. Data collected was analysed using Statistical Package for Social Sciences for windows software, version 12.0. Results: There was a high level of awareness among UPTH health workers of the different waste types and their hazardous nature. A majority of the respondents showed favourable attitudes towards the importance of guidelines on medical waste management and training in, and use of personal protective equipment. Also the staff avoided certain aspects of their jobs they considered risky. The study also showed that the procedure of medical wastes management i.e. generation, segregation, storage, treatment, and final disposal at the UPTH was inadequate. Conclusion: The knowledge, attitude, and practice of the UPTH members of staff regarding management of medical wastes appeared satisfactory. The procedure of wastes management at the hospital appeared inadequate. We recommend that health education on medical wastes management be aggressively pursued as a policy. Keywords: Medical waste management, UPTH, Personal protective equipment, Generator responsibilities

Sharp disposal practices in urban dispensaries

Sir, Bio-medical waste means waste generated during the process of diagnosis, treatment and/or immunization of human beings or animals or in research activities pertaining thereto or in the production or testing of biological. Injections are among the most frequently used medical procedure with an estimated 12 to 16 billion injections administered each year worldwide. (1) According to IPEN study, 03-06 billion injections are administered annually in India. (2) A large majority of them are administered for curative purpose and rest for immunization. An injection is considered to be safe when it does no harm to the recipient, does not expose the health care worker to any risk and does not result in waste that is dangerous to the community. (3) Although sharps waste constitutes a small proportion of all health care waste, its inadequate management can cause direct negative impact on health personnel and community and in addition, pollute the environment. A study was conducted to assess injection [immunization] waste disposal practices in urban dispensaries of Delhi, India. Primary data were collected by a single investigator using observation checklist based on Government of India guidelines (4) during the period October 2005 to March 2006. All [32] government dispensaries operational in a randomly selected municipal zone of Delhi, India were covered after obtaining permission from competent authorities. Owing to limited resources, only one visit was made to each health facility and best of five injections were observed to comment on disposal practices and method of terminal waste disposal from the dispensary was also observed and/or recorded. Results are thus presented according to health facility. All the health facilities were using AD [auto-disable] syringes for primary immunization of children. Correct needle disposal practices [needle shredding/chemical disinfection] and incorrect practices [needle bent/recapped with both hands] were observed in equal number (16 [50.00%]) of health facilities respectively. It was noticed that dedicated bio-medical waste transport service was available in 18 [56.25%] health facilities only as per regulatory stipulation for transfer of biomedical including immunization waste to common biomedical treatment facility. Rest of the health facilities i.e. 14 (43.75%) were either disposing off their entire immunization waste into nearby general municipal waste containers [dhalao] or were burning in uncontrolled manner [Figure 1]. An interesting observation was made that incorrect needle practices were more prevalent in those health facilities that had provision of dedicated BMW transport service suggestive of carelessness/need for attitudinal change [Table 1]. Table 1 Sharp disposal practices according to health facilities Figure 1 Uncontrolled burning of AD syringes in a dispensary BMW labeled colored coded bags were used in 29 [90.62%] health facilities for disposing immunization waste; however, varying color bags were in use. All the injection-related waste was also thrown in respective available bags. Red-colored bags were used in 16 [50.0%], blue bags in 11 [34.37%], and yellow bags in 2 [6.25%] health facilities, respectively. The reason cited was logistic issues. The cut-needle that was collected using hub cutter was emptied back directly into plastic/cardboard container at the end of immunization day or was being preserved in the hub cutter itself till it got completely filled. It was heartening to note that there was no littering of injection waste in or around any of the health facilities. IPEN study on ‘Assessment of Injection Practices in India’ reported satisfactory immunization waste disposal in 50.0% of health facilities only. There are multiple government health agencies in Delhi that are providing health services including immunization to community. Some of these agencies had outsource to vendors the practice of transporting biomedical including immunization waste to common biomedical treatment facility in accordance with Bio Medical Waste Management and Handling Rules, 1998 while in rest this was not made available. To conclude, corrective interventions are required at two levels i.e. one at individual/health facility and another at health agency level. It is the organizational responsibility to coordinate and make available dedicated bio-medical waste transport services including other logistics, which is also binding on them as per statutory requirement. Re-orientation training/sensitization of health personnel at periodic interval may instill in safe BMW management practices. Similarly, close monitoring and supervision is required by medical officers at individual level to ensure correct waste disposal practices by health workers.

Medical waste management in Ibadan, Nigeria: Obstacles and prospects

Quantification and characterization of medical waste generated in healthcare facilities (HCFs) in a developing African nation has been conducted to provide insights into existing waste collection and disposal approaches, so as to provide sustainable avenues for institutional policy improvement. The study, in Ibadan city, Nigeria, entailed a representative classification of nearly 400 healthcare facilities, from 11 local government areas (LGA) of Ibadan, into tertiary, secondary, primary, and diagnostic HCFs, of which, 52 HCFs were strategically selected. Primary data sources included field measurements, waste sampling and analysis and a questionnaire, while secondary information sources included public and private records from hospitals and government ministries. Results indicate secondary HCFs generate the greatest amounts of medical waste (mean of 10,238 kg/day per facility) followed by tertiary, primary and diagnostic HCFs, respectively. Characterised waste revealed that only approximately 3% was deemed infectious and highlights opportunities for composting, reuse and recycling. Furthermore, the management practices in most facilities expose patients, staff, waste handlers and the populace to unnecessary health risks. This study proffers recommendations to include (i) a need for sustained cooperation among all key actors (government, hospitals and waste managers) in implementing a safe and reliable medical waste management strategy, not only in legislation and policy formation but also particularly in its monitoring and enforcement and (ii) an obligation for each HCF to ensure a safe and hygienic system of medical waste handling, segregation, collection, storage, transportation, treatment and disposal, with minimal risk to handlers, public health and the environment.

Assessment of medical wastes management practice: A case study of the northern part of Jordan

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053–0.065 kg/test-day for governmental laboratories, and 0.034–0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.

An analysis of possible scenarios of medical waste management in Bangladesh

This study investigated medical waste management (MWM) practices in Bangladesh: its present constraints, the health effect of existing practices, and the weaknesses of the current system. Suggestions for improvement of the MWM situation have also been offered. Those interviewed included hospital staff, waste pickers and local residents. In‐depth field observations and a questionnaire survey were conducted in June‐July 2000 and March 2001. Laboratory analyses of medical waste were done on different occasions from 1998‐2001. Analyses of medical waste showed severe contamination of pathogenic microorganism and respondents suffered from various infectious diseases. The study identified the absence of rigorous laws related to MWM practices. It is a necessity to improve the handling and disposal methods of medical waste in almost all the available medical facilities.

Disposal options for infectious medical waste generated during home-based dental care.

The number of dentists providing mobile care is increasing. One of the challenges the mobile dentist faces is proper handling and disposal of infectious medical waste generated during patient care. Mobile dentists must concern themselves with meeting Federal, state, and local regulations. Federal agencies that have jurisdiction over this issue are the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA). EPA guidelines are summarized and clarified with respect to pre-transportation and transportation issues. Compliance with OSHA standards are addressed through presentation of a sample protocol for handling infectious medical waste. It is beyond the scope of this paper to discuss in detail the policies of each municipality, and practitioners are advised to consult with state and local authorities regarding proper handling and transportation of this material. Using the information presented in this paper, the mobile dentist can approach this complex issue in an organized manner.

Managing medical waste technology: how US hospitals adapted to change

A total of 78 US hospitals responded to a survey in a nation-wide sample for the purpose of analysing their medical waste technology management practices under changing laws and regulations in the early 1990s. Findings show that 77%; of these hospitals implemented changes in one or more of their operations in storage, treatment, handling, transport and disposal of medical waste and staff training because of federal, state or local laws. The article includes backgrounds of those responsible for managing this technology, various hospital problems encountered, benefits and costs of implementing these laws, and roles of infectious control committees. A brief discussion of the US Medical Waste Tracking Act is included. Global implications and future needs are also discussed.

Medical waste handling system

Medical waste handling system

A Medical Waste Management Strategy

Because medical waste may present potential hazards to employees, waste handlers and the general public, all facilities generating this form of waste should develop and implement a medical waste management strategy. This strategy should be prepared after conducting a survey to determine the types and estimated amounts of medical waste generated by the facility. The strategy should address medical waste handling, including segregation, packaging, in‐house transport and storage. The management plan must also prescribe appropriate treatment procedures for contaminated waste, and designate proper methods for final disposal of medical wastes and treatment residues. Finally, the facility must ensure the implementation and monitoring of this strategy.

Incidence of Hepatitis-B Among Healthcare Professionals due to Medical Waste Handling

The incidence of hepatitis-B among health care workers due to medical waste handling has been a subject of interest. A hospital base survey was done in Chittagong Medical College Hospital (CMCH), Chittagong during the period of April 2009 through June 2009 among health care workers was done to identify the problem. All types of health care workers especially those are very much vulnerable to needle stick puncture like nurses, ward boys, cleaners, laboratory technicians and doctors were included in this study.Total number of respondents was one hundred (sixty eight male and thirty two female). Age of the respondents ranged from 20-60 years with on average age of 24 ± 5.5 years. 62% of health care workers do not aware of hazards of medical waste. Only 38% are aware of infectious medical waste. Among them only 12% learned about the hazards of medical waste from hospital authority. Rest of them is aware of this implication from personal information. All of the health care workers claimed that they have no training on medical waste handling safely. Even they do not take any protective measure. 66% of the health care workers of different service type were punctured at least once or several times. So the puncture rate was counted with special attention. Sixty percent of ward boys, 90% of nurses, 25% of doctors and 80% of laboratory technicians were punctured once or several times within their job duration.These 5% health care workers were HbsAg positive. Among them one ward boy, two nurses, one cleaner and one laboratory technician were infected with hepatitis B virus. All of them had history of needle stick puncture. One HbsAg positive case was excluded from this study because of history of blood transfusion. Waste sharps are considered highly infectious medical waste causing hepatitis B frequently. Key words: Medical waste; occupational risk; hepatitis B. DOI: 10.3329/jdmc.v18i2.6275 J Dhaka Med Coll. 2009; 18(2) : 140-143