Healthcare Waste Disposal Research Articles

Chemical healthcare waste management in small Brazilian municipalities

The disposal of healthcare waste (HCW) seems to have been solved in developed countries, while in most developing countries the problem persists because the disposal methods are expensive and larger than the budget of small- and medium-sized municipalities. The current study evaluates the encapsulation process for the disposal of medical chemical waste. The experiment was developed in the Piraí municipality (Rio de Janeiro State, Brazil) and the chemical wastes were produced in the local public hospital, as well as the 12 units of primary care health services. Chemical waste generated at health services units may include the liquid waste from cleaning materials and disinfectants, expired and unused pharmaceutical products, and cytotoxins. These are all considered hazardous waste products and they must be disposed of via an authorised system at approved sites (e.g. industrial landfills). The process of encapsulating chemical medical waste in concrete (cement, crushed stones and sand) followed by their disposal at sanitary landfills is a procedure that is not considered in Brazilian Legislation. Despite the oversight, this method of disposal was used in the municipality of Piraí, with the approval of the Rio de Janeiro State Agency for Environmental Control. The safety aspects of this method and the limits of its applicability, particularly in small municipalities, were evaluated in this study. The results indicate that, within certain parameters, this method may provide a viable solution for the disposal of HCW in small municipalities.

Management of healthcare waste: developments in Southeast Asia in the twenty-first century

In many Southeast Asian countries, significant challenges persist with regard to the proper management and disposal of healthcare waste. The amount of healthcare waste in these countries is continuously increasing as a result of the expansion of healthcare systems and services. In the past, healthcare waste, if it was treated at all, was mainly incinerated. In the last decade more comprehensive waste management systems were developed for Southeast Asian countries and implementation started. This also included the establishment of alternative healthcare waste treatment systems. The developments in the lower-middle-income countries are of special interest, as major investments are planned. Based upon sample projects, a short overview of the current development trends in the healthcare waste sector in Laos, Indonesia and Vietnam is provided. The projects presented include: (i) Lao Peoples Democratic Republic (development of the national environmental health training system to support the introduction of environmental health standards and improvement of healthcare waste treatment in seven main hospitals by introducing steam-based treatment technologies); (ii) Indonesia (development of a provincial-level healthcare waste-management strategy for Province Nanggroe Aceh Darussalam (NAD) and introduction of an advanced waste treatment system in a tertiary level hospital in Makassar); and (iii) Vietnam (development of a healthcare waste strategy for five provinces in Vietnam and a World Bank-financed project on healthcare waste in Vietnam).

A fuzzy multi-criteria group decision making framework for evaluating health-care waste disposal alternatives

Nowadays, as in all other organizations, the amount of waste generated in the health-care institutions is rising due to their extent of service. Medical waste management is a common problem of developing countries including Turkey, which are becoming increasingly conscious that health-care wastes require special treatment. Accordingly, one of the most important problems encountered in Istanbul, the most crowded metropolis of Turkey, is the disposal of health-care waste (HCW) from health-care institutions. Evaluating HCW disposal alternatives, which considers the need to trade-off multiple conflicting criteria with the involvement of a group of experts, is a highly important multi-criteria group decision making problem. The inherent imprecision and vagueness in criteria values concerning HCW disposal alternatives justify the use of fuzzy set theory. This paper presents a fuzzy multi-criteria group decision making framework based on the principles of fuzzy measure and fuzzy integral for evaluating HCW treatment alternatives for Istanbul. In group decision making problems, aggregation of expert opinions is essential for properly conducting the evaluation process. In this study, the ordered weighted averaging (OWA) operator is used to aggregate decision makers’ opinions. Economic, technical, environmental and social criteria and their related sub-criteria are employed to assess HCW treatment alternatives, namely “incineration”, “steam sterilization”, “microwave”, and “landfill”. A comparative analysis is presented using another classical operator to aggregate decision makers’ preferences.

Healthcare waste management in clinics in a rural health district in KwaZulu-Natal

The handling of healthcare waste (HCW) was investigated in 30 rural healthcare facilities in KwaZulu-Natal. Using a semi-structured questionnaire, interviews were carried out with the person in charge of the facility and observations were made to establish current practices in sorting, handling and disposal of HCW. It was found that improper sorting and management of HCW occurred on most sites with implications for cost, infection control and education. It is imperative therefore that improved HCW management measures be implemented and that healthcare facility staff receive appropriate and repeated training to ensure minimising risk.

What a waste

Abstract Four years on from new rules on the disposal of healthcare waste there is still a lack of knowledge on the profession’s responsibilities. John Bonner speaks to Mike Jessop about the problem.

Healthcare waste management in Asia

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties - budget support, developing policies and legislation and technology and knowledge management.

Sustainable management measures for healthcare waste in China

This paper discusses actions aimed at sustainable management of healthcare wastes (HCW) in China, taking into account the current national situation in this field, as well as the requirements deriving from the Stockholm Convention on Persistent Organic Pollutants and the WHO recommendations. By the end of 2005, there were 149 low-standard HCW disposal facilities in operation in China, distributed throughout different areas. According to the National Hazardous Waste and Healthcare Waste Disposal Facility Construction Plan, 331 modern, high-standard, centralized facilities will be built up in China in municipal level cities. Although incineration is still the main technical option for HCW disposal in China, it is expected that, especially for medium and small size facilities, non-incineration technologies will develop quickly and will soon become the main technical option. The basic management needs – both from the point of view of pollution control and final disposal – have been defined, and a system of technical and environmental standards has been formulated and implemented; however, there are still some shortages. This is particularly true when considering the best available techniques and best environmental practices developed under the Stockholm Convention, with which the present technological and managing situations are not completely compliant. In this framework, the lifecycle (from generation to final disposal of wastes) of HCW and holistic approaches (technology verification, facilities operation, environmental supervision, environmental monitoring, training system, financial mechanism, etc.) towards HCW management are the most important criteria for the sustainable and reliable management of HCW in China.

Changing infection control behaviour in Egypt

The infection control unit at the Theodor Bilharz Research Institute in Egypt describes how it responded to the challenge of changing a culture of infection control practice in the workplace. Improved disposal of healthcare waste, the introduction of hand hygiene facilities and the design of a central sterilisation unit are some of the measures being introduced to raise awareness of infection control in the institute. The team also found that mupirocin nasal applications on healthcare workers with MRSA colonisation resulted in nasal carriage clearance.

Biomedical waste management in nursing homes and smaller hospitals in Delhi

The management of biomedical waste is a crucial issue in health and environmental management. Rules in India were promulgated in 1998, originally with a deadline of December 2000 and extended to December 2002; however, the actual situation remains far from satisfactory. A study conducted in 2001 by CEE, New Delhi; indicated an implementation deficit. To gauge the present situation, a survey was undertaken during 2005-2006. A systematic analysis of current biomedical waste management practices in smaller nursing homes and hospitals in Delhi was carried out. A total of 53 nursing homes, with bed strengths ranging from 20 to over 200, were included. The survey results show that there is a marked improvement in the segregation practices of biomedical waste in small private hospitals and nursing homes. The majority of nursing homes and hospitals were found to be using a service provider for the collection, management, and disposal of healthcare wastes. Data was collected through a questionnaire and field visits. This paper discusses the relevant data indicative of current practices of healthcare waste management in the nursing homes and small healthcare facilities in Delhi.

Dental health care waste disposal among private dental practices in Bangalore City, India

Any waste generated consequent to health care activity including any from a home environment is health care waste. Dental practices generate large amounts of waste cotton, plastic, latex, glass and other materials much of which may be contaminated with body fluids. To assess the knowledge, attitude and behaviour of private dental practitioners on health care waste management in Bangalore City. A cross-sectional study of 432 private dental practitioners in Bangalore City using a self-administered questionnaire. 389 dentists responded; 64.3% do not segregate waste before disposal and 47.6% hand over health care waste to street garbage collectors; 42.1% felt that there was a lack of waste management agency services and 16.9% felt that a lack of knowledge were the main hurdles. Dentists need education regarding health care waste disposal methods to improve their knowledge. A large proportion of the dentists are not practising proper methods of health care waste disposal. The existence of legislation governing healthcare waste disposal is not sufficient alone to motivate many practitioners to comply with guidelines.

Management of Waste from Health Care Institutions

AbstractEfficient health‐care waste management is crucial for the prevention of the exposure of health care workers, patients, and the community to infections, toxic wastes and injuries as well as the protection of the environment, according to the World Health Organization. Health care waste is classified according to local governmental directives. These, as well as the disposal of the different waste streams vary extremely between different countries. This requires country specific solutions for disposal of health care wastes. Since 1989 the author participates in hospital waste management projects for the Gesellschaft für Technische Zusammenarbeit (GTZ) and the Senior Expert Service (SES) in Brazil, Thailand, and Ghana. In 2003 she founded the consultancy “Meyro‐Consulting” (www.meyro‐consulting.de).

Treatment and disposal alternatives for health-care waste in developing countries – a case study in Istanbul, Turkey

Efficient health-care waste management is crucial for the prevention of the exposure of health-care workers, patients, and the community to infections, toxic wastes and injuries as well as the protection of the environment (Safe Management of Wastes from Health-care Activities. World Health Organization, Geneva). The amount of health-care waste produced in the Istanbul Metropolitan City in Turkey is 30 ton day(-1) in total. The method used for the final disposal of most of the health-care waste of Istanbul is incineration. However, a great portion of the infectious waste is disposed of with the domestic waste into the sanitary landfill because of improper segregation practices applied in the health-care institutions. Therefore the alternatives for the treatment and disposal of health-care waste were evaluated. The technical information related to the available treatment technologies including incineration, microwave irradiation, mobile or stationary sterilization, etc. were also investigated. The capital investment cost, transportation/operational costs for each alternative method and the different locations for installation were compared. When the data collected were evaluated, it was found that separate handling and disposal of health-care waste generated on the European and the Asian sides of the city was the most economic and practicable solution. As a result, it was concluded that the capacity of the Kemerburgaz-Odayeri incineration plant is enough to incinerate the health-care waste generated on the European side of Istanbul, the construction of a new incineration plant or a stationary sterilization unit for the disposal of health-care waste generated on the Asian side was the most effective alternative.

Alternatives for the treatment and disposal of healthcare wastes in developing countries

Waste production in healthcare facilities in developing countries has brought about a variety of concerns due to the use of inappropriate methods of managing the wastes. Inappropriate treatment and final disposal of the wastes can lead to adverse impacts to public health, to occupational health and safety, and to the environment. Unfortunately, most economically developing countries suffer a variety of constraints to adequately managing these wastes. Generally in developing countries, few individuals in the staff of the healthcare facility are familiar with the procedures required for a proper waste management program. Furthermore, the management of wastes usually is delegated to poorly educated laborers who perform most activities without proper guidance and insufficient protection. This paper presents some of the most common treatment and disposal methods utilized in the management of infectious healthcare wastes in developing countries. The methods discussed include: autoclave; microwave; chemical disinfection; combustion (low-, medium-, and high-technology); and disposal on the ground (dump site, controlled landfill, pits, and sanitary landfill). Each alternative for treatment and disposal is explained, including a description of the types of wastes that can and cannot be treated. Background information on the technologies also is included in order to provide information to those who may not be familiar with the details of each alternative. In addition, a brief presentation of some of the emissions from each of the treatment and disposal alternatives is presented.

Healthcare Wastes: A World Health Organization Perspective on Waste Treatment and Disposal Options (Abridged)

ABSTRACTDuring the last three decades, the World Health Organization has been actively involved in assisting countries and health authorities to improve their healthcare waste management. Wide disparities exist internationally on the standards of treatment and disposal of healthcare wastes which are achievable and sustainable in individual countries and localities. Three levels of practice can be identified: (i) a ‘foundation’ level in which some improvement in hospital hygiene and public health is achieved by removing wastes from wards to simple burning grounds and landfills, (ii) an ‘intermediate’ level whereby more organized collection and treatment is possible, and (iii) a more ‘sophisticated’ level involving treatment, enforcement of strict emission standards and landfilling regulations.This paper summarizes the range of practices in use and the options for (a) thermal treatment, (b) alternative technologies, and (c) engineered landfill. Details are also given on some of the activities undertaken by the World Health Organization in the areas of advice and guidance, direct assistance and research.

Managing biomedical waste in Ontario: a regional approach.

The lack of landfill space, public perceptions, the escalating costs of disposal, and other factors have created a controversial environment for the disposal of healthcare waste. In the province of Ontario, a proposal has been made that aims to make Ontario self-sufficient in its management of healthcare waste through the use of regional incineration facilities. This article examines this proposal as well as other available options for Ontario's healthcare facilities.