Healthcare Waste Research Articles

Global Perspectives on Healthcare Waste Management and Bibliographic Mapping during the Crises of COVID-19

The lack of proper waste management of health care facilities can have a significant negative health impact on the global population. This study provides a critical view on the current state of the existing healthcare waste management practices used in healthcare facilities around the world during the Coronavirus disease 2019 (COVID-19) pandemic outbreak. The increasing amount of COVID-related healthcare waste was analyzed and classified to provide justification for the urgent need to develop waste management standards that ensure safe containment and diversion of hazardous and non-hazardous wastes through recycling, reuse and repurposing. The waste handling, treatment, and disposal management of healthcare waste from various COVID-infected locations such as homes, quarantine centers, camps, and hospitals have been reviewed. A total of 100 documents on COVID-19 related healthcare waste were published on the Web of Science database over the 2020-2022 period. Innovative solutions for effective waste treatment and disposal, related government policies and regulations, and literature survey supported by VOSviewer-aided detailed bibliographic analysis are presented and critically discussed. Thus, the present research output advocates for a paradigm shift towards circular economy principles in healthcare waste management, emphasizing waste reduction, recycling, and recovery, and encourages global cooperation to develop resilient, crisis-responsive waste management systems.

A Web-Interface Based Decision Support System for Optimizing Home Healthcare Waste Collection Vehicle Routing

Background: The significant increase in home healthcare (HHC) driven by technological advancements, an ageing population, and heightened disease outbreaks—especially evident during the COVID-19 pandemic—has created an urgent need for improved medical waste management. Methods: This paper presents the development of a decision support system with a web-based interface designed for efficient medical waste collection in the HHC sector. Results: The system utilises Flask for backend operations, with HTML and CSS for the user interface, and manages data using JSON files. Its flexible design supports real-time adjustments for various vehicle types and changing waste production locations. It incorporates dynamic routing by employing two sophisticated metaheuristic algorithms: the Strength Pareto Evolutionary Algorithm (SPEA-2) and the Non-Dominated Sorting Genetic Algorithm (NSGA-II). This setup supports different dataset sizes and vehicle fleets, including Internal Combustion Engine (ICE) vehicles and Electric Vehicles (EVs). Conclusions: The automation reduces uncertainties in waste collection by minimising human intervention. The system is built to be easily adaptable for other sectors with minor modifications and can be expanded to test various scenarios with new selectable parameters.

Shallow Shotgun Sequencing of Healthcare Waste Reveals Plastic-Eating Bacteria with Broad-Spectrum Antibiotic Resistance Genes

Shallow Shotgun Sequencing of Healthcare Waste Reveals Plastic-Eating Bacteria with Broad-Spectrum Antibiotic Resistance Genes

Healthcare waste management and antimicrobial resistance: a critical review

ABSTRACT The rapid growth of populations and urbanization has led to a significant increase in healthcare waste, posing serious health risks. A search on Google Scholar identified seven relevant articles from Ethiopia that examine the relationship between improper waste management in healthcare facilities (HCFs) and the rise of antimicrobial resistance (AMR) genes. This review aims to highlight key concepts, evidence sources, and knowledge gaps specific to the Ethiopian context. The unsafe disposal of antibiotics through leaks and solid waste has contributed to what some are calling a ‘silent pandemic,’ raising concerns about emerging infectious diseases. Studies have revealed alarming rates of infectious agents and AMR in healthcare wastewater. Isolates of C. jejuni, Escherichia coli, Enterococcus faecalis, and Enterococcus faecium from various healthcare waste sites in Ethiopia demonstrate high levels of AMR genes. Additionally, research indicates that HCFs produce significant amounts of waste, with high per-person daily waste production rates. Leachate from landfills containing this waste can negatively affect soil health, biological activity, water quality, agriculture, animal health, and human well-being. To mitigate these risks, effective waste management practices and the promotion of alternative antimicrobial use are essential strategies for reducing the emergence of pandemic diseases in developing countries.

A cradle-to-grave life cycle assessment of the endoscopic sinus surgery considering materials, energy, and waste.

Operating rooms generate 1.8 million tons of waste annually, or 20%‒30% of the total healthcare waste in the United States. Our objective was to perform a life cycle assessment (LCA) for endoscopic sinus surgeries (ESSs) in order to analyze its environmental impact. A comprehensive LCA of ESS was performed considering energy, climate, and water use impacts associated with the materials and processes used. It focuses on the ESS performed at a large tertiary academic hospital and then extends the impacts to consider annual US surgeries. The assessment considers end-of-life waste management at both landfills and incinerators. Single-use instrument production constitutes 89%‒96% of the total impacts throughout the life cycle of an ESS. Waste-to-energy incineration is shown to be a preferred end-of-life destination, as it recovers much of the input production energy of plastic items, ultimately reducing the input to 36%, although this is done at the expense of higher greenhouse gas emissions. For multi-use items, decontamination dominates environmental impact (>99% of totals), but consideration of reusable items reduces overall energy consumption and global warming potential (GWP) by 25%‒33%. Single-use items dominate the total environmental impact of ESS. While multi-use items require additional decontamination over their lifetimes, results show that their incorporation reduces energy consumption and GWP by 25%‒33%, demonstrating the clear environmental benefit.

The Superego of the City: Integrating Psychoanalytic Theory with Sustainable Urbanization in the Age of Industry 4.0

This article introduces the concept of the "superego of the city" by drawing on Freudian psychoanalytic theory to explore the ethical and moral dimensions of contemporary urbanization. As cities undergo rapid transformation driven by metropolization, digitalization, and environmental challenges, traditional urban analysis frameworks have become increasingly inadequate. The "superego of the city" provides a theoretical framework for understanding how urban spaces preserve cultural identity, foster social cohesion, and promote environmental sustainability amid these ongoing changes. By applying this concept to smart city initiatives—specifically in the realm of healthcare waste management—this study demonstrates how the integration of Circular Economy (CE) principles with Industry 4.0 technologies can align technological advancements with the ethical imperatives embodied in the city's collective consciousness.

Machine learning-based lean service quality improvement by reducing waiting time in the healthcare sector

PurposeThe study presented healthcare service quality, lean thinking and Six Sigma to enhance patient satisfaction. Moreover, the notion of machine learning is combined with lean service quality to bring about the fundamental benefits of predicting patient waiting time and non-value-added activities to enhance patient satisfaction.Design/methodology/approachThe study applied the define, measure, analyze, improve and control (DMAIC) method. In the define phase, patient expectation and perception were collected to measure service quality gaps, whereas in the measure phase, quality function deployment (QFD) was employed to measure the high-weighted score from the patient's voice. The root causes of the high weighted score were identified using a cause-and-effect diagram in the analysis phase.FindingsThe study employed a random forest, neural network and support vector machine to predict the healthcare patient waiting time to enhance patient satisfaction. Performance comparison metrics such as root-mean-square error (RMSE), mean absolute error (MAE) and R2 were accessed to identify the predictive model accuracy. From the three models, the prediction performance accuracy of the support vector machine model is better than that of the neural network and random forest models to predict the actual data.Practical implicationsLean service quality improvement using DMAIC, QFD and machine learning techniques can be generalized to predict patient waiting times. This study provides better realistic insights into patient expectations by announcing waiting times to enable data-driven service quality deliveries.Originality/valuePrior studies lack lean service quality, Six Sigma and waiting time prediction to reduce healthcare waste. This study proposes lean service quality improvement through lean Six Sigma (LSS), i.e. DMAIC and machine learning techniques, along with QFD and cause-and-effect diagram.

Accounting and Healthcare Waste Management: Strategies to Improve Financial Efficiency and Reduce Environmental Impact

Healthcare waste management represents both a financial and environmental challenge for healthcare institutions. This article discusses accounting and financial management strategies that can be implemented to optimize operational costs related to healthcare waste disposal, while minimizing environmental impact. A theoretical framework based on financial and environmental sustainability is proposed, integrating environmental accounting policies and waste management methodologies. The results demonstrate that adequate financial planning and the implementation of treatment technologies can significantly reduce costs and improve efficiency in healthcare waste management. The findings highlight the need for more robust management policies and greater investment in sustainable treatment technologies.

Impact of an educational training about healthcare waste management on practices skills of healthcare workers: a prexperimental study in a tertiary Tunisian hospital

BackgroundHealthcare waste (HCW) poses a global hazard, particularly in developing country hospitals where mismanagement is common due to poor practices among staff. Training healthcare workers has shown promise in enhancing practices and behaviors. The aim of this study was to assessHCW management at Sahloul University Hospital (2019–2021) before and after training sessions.MethodsThis study was conducted at Sahloul University in Sousse, Tunisia, spanned two years (2019–2021) and consisted of three distinct stages. Two audits of Healthcare Waste Management (HCWM) were conducted using a predetermined assessment framework derived from ANGED’s guidelines, with an educational session separating the two audits.ResultsIn terms of sorting practicesthere was a substantial improvement in sorting practices following training. Specifically, the overall compliance rate for sorting sharps increased from 60.3 to 77.6% (p < 10 − 3), and for sorting soft and solid waste, it rose from 32.5 to 72.4% (p < 10 − 3) in 2021. Overall, resource indicators demonstrated improvement between 2019 and 2021, the compliance rate for the intra-service collection step increased from 31.3 to 58.2%. However, we observed persistent inadequacies in container and bag labeling, as well as challenges in tracing the time of healthcare waste collection.ConclusionTraining led to significant improvements in HCW management practices among healthcare workers, though some areas still need enhancement.

A review on digital transformation in healthcare waste management: Applications, research trends and implications.

At present, both emerging and developed economies have faced the challenge of higher healthcare waste generation. Developed countries are using these technologies to manage healthcare waste and cope with the challenge. Emerging economies are still struggling to understand and implement digital technologies in healthcare waste management, posing a danger to partners handling toxic and hazardous waste. The proper handling of healthcare waste is essential for social and environmental sustainability. Digital technologies that drive digital transformation in the healthcare sector impact the traditional way of managing healthcare waste. Digital technologies include artificial intelligence, blockchain, the Internet of Things, sensors, data analytics and radio frequency identification. These technologies can potentially address vehicle route planning and scheduling problems, resource optimisation, real-time tracking and the visibility of healthcare waste management. Apart from economic and environmental concerns, the operational workforce also takes care of societal well-being and implements waste management strategies and policies. Past research has focused on integrating blockchain technology to enhance traceability and transparency in waste collection and disposal activities. However, the application and impact of these technologies for managing different operations of healthcare management with sustainability is a gap bridged by the present study. This study adopts a systematic literature review to identify research trends, applications and implications of digital transformation. It proposes a digital technology-driven framework for healthcare waste management for further research.

Use of the value-focused thinking methodology to understand health care waste management under the perspective of occupational and environmental health

The increasing generation of healthcare waste has greatly accelerated the concern about its potential negative environmental and public health effects. In this sense, the application of decision-making methods and techniques at a strategic level has become increasingly indispensable for the management of health units. This article aimed to understand the challenges in healthcare waste management (HCWM), the main mechanisms of action and values. The Value-Focused Thinking methodology was used to evidence important gaps and propose improvements in the context of decision on occupational safety and environmental protection, leading to the creation of alternatives not seen previously and guaranteeing the good ideas would be converted into actions. The structure was developed by semi-structured questionnaires, observation lists and interviews, conducted to expose the values of the main stakeholders (managers, health professionals, and cleaning professionals) of 10 public health units selected in Caruaru (Brazil). As a result, the investigation evidenced four fundamental goals for the decision context: improvement in work and environmental safety; improvement in HCWM practices; improvement in resource management; strengthening of the stakeholder communication network. From the analysis of the attributes associated with the fundamental goals, it was possible to identify actions that should be implemented with a higher priority and, in the short term, aiming at obtaining positive results, especially in the management practices and the safe management of health waste. The study resulted from an investigation that awakened the participants about aspects little questioned in everyday life. Implementing actions to segregate and recycle materials, with data monitoring and sharing, will increase the population's trust and the environment's and professionals' safety. The alternatives derived from the VFT method consider the perspectives of key stakeholders in HCWM, helping decision-makers and policymakers develop more assertive and grounded management strategies.

Gestion des déchets associés aux soins et éco responsabilité des cabinets dentaires en Tunisie : Enquête nationale

AIM or PURPOSE: The increasingly production of medical waste(MW) is a public health problem. The impact on human health and environment are very important. The aim of this study was to evaluate the practices and knowledges of Tunisian dentists about this field of interest.MATERIALS and METHOD: We conducted a cross sectional study. A self-administered questionnaire of 29 questions was published in a specific group of dentists in the social media. Data were collected immediately on GoogleForms and treated with SPSS.RESULTS: We collected 187 responses, of whom 82.8% were concerned about the impact of their practice on the environment. Practitioners who had been in practice for more than 10 years were more concerned about this issue (p=0.022).In 87,71% of cases, they stored the MW separetly, 12.3% outsourced to a waste management company. For the remaining, 95.12% of them disposed of in public bins. Most participants (87.3%) did not have a special container for sharps waste. Amalgam waste was disposed of with other waste for 35% of participants, increasing the risk of air and water contamination. The majority of participants used digital radiography (83.5%).Most participants (92.5%) had not received any training in healthcare waste management.CONCLUSION(S): There was a gap in the knowledge of proper MW management among Tunisian dentists. This issue must be a priority for the various national stakeholders involved, because protecting the environment is the responsibility of all of us. We must preserve this planet for future generations.

Reducing healthcare waste by eliminating exam table paper in a primary care practice: a sustainable quality improvement initiative.

Climate change is now the greatest threat to human survival. The healthcare system contributes significantly to global pollution and greenhouse gas emissions. Individual practitioners play an important role in helping to reduce these impacts in day-to-day practice. Deimplementation of unnecessary processes and products, such as exam table paper, in medical offices is one simple approach to incorporating principles of planetary health into practice. All quality improvement (QI) projects must start to consider environmental impacts to fully evaluate change ideas. We designed a single Plan-Do-Study-Act cycle using the Institute for Health Improvement Model for Improvement. We removed the exam table paper from our primary care office and measured changes in staff time, laundry, financial costs, paper use and carbon dioxide (CO2) emissions. Eliminating exam table paper in our clinic resulted in modest annual cost savings of $C718 and improved staff efficiency and motivation to introduce other green office practices. In our clinic alone, this change will save 8.2 km of exam table paper, 10 trees and 148 kg of CO2e (equivalent to driving 1233 km) every year. There were no negative consequences or feedback. This simple QI project demonstrates the feasibility of implementing a small change in a primary care clinic that can improve environmental sustainability with multiple co-benefits. If all family physicians in Canada eliminated exam table paper in their offices, it would result in savings of approximately 95 940 km of paper, 121 680 trees, $C8 400 600 and 3054 T CO2 emissions, equivalent to driving around the world 360 times.

Optometrists’ experience of healthcare fraud, waste and abuse (FWA) and strategies to combat it

Background: South African private healthcare is funded through medical aids and out-of-pocket payments. Annually, R22 billion is lost to medical fraud, waste and abuse (FWA) threatening the sustainability of healthcare delivery. Healthcare providers are often accused of unethical practices and various forms of FWA.Aim: To assess the optometrists’ experience of FWA and the strategies to combat FWA.Methods: A quantitative study was conducted amongst optometrists using a structured questionnaire and data was analysed using descriptive statistics.Results: Most (75%) respondents were aware of FWA. About 41% of respondents were audited for FWA, of whom two-thirds were Black males. The Preferred provider Negotiators conducted 27% audits, followed by Discovery (16.5%), Government Employees Medical Scheme (7.8%) and Medscheme (5%). Iso Leso and Opticlear networks conducted 3.9% each. About 7.8% were found guilty of FWA, of whom 87.5% were Black practitioners and 12.5% Indian practitioners. Claiming for spectacles but dispensing sunglasses (5.9%) and over-servicing (4%) were highest ranked offences. Common sanctions were claw-back (75%) and indirect payment (37.5%). Practitioners implement identity checks (94%–96%), coding training (89%) and accurate record keeping (93%) as anti-FWA strategies. Excessive codes and lack of standardised tariffs were challenges to fighting FWA.Conclusion: Optometrists use identity checks, coding and billing training as anti-FWA strategies. Coding and billing complexities are the main sources of FWA cases. Black and Indian practitioners were more likely to be identified for FWA and found guilty than White practitioners.Contribution: The study highlights the forms of FWA and suggest integration of controls to effectively curb FWA.

A multi-objective mathematical programming model for location-routing of COVID-19 healthcare waste in Tunisia

A multi-objective mathematical programming model for location-routing of COVID-19 healthcare waste in Tunisia

Evaluation of a training programme on the management of infectious and sharp healthcare waste in Tunisia

IntroductionThe management of healthcare waste is a crucial issue for public health and the environment. To minimise risks, it is essential to ensure that the management of healthcare waste is...

Economic evaluation of hazardous healthcare waste treatment systems

The cost estimation and assessment of healthcare waste treatment systems (HCWTSs) for preventing financial and environmental damage are essential. This work reports economic analyses of treatment of hazardous–infectious waste based on WHO approach in HCWTSS of 43 hospitals in Tehran, Iran. The waste generation rate for total hospital waste in 43 HCWTSS was 4.42 ± 2.77 kg/active-bed/day. The mean of chemical, sharps, infectious, and general wastes in 43 HCWTSS were 13.79 ± 19.71, 30.29 ± 37.46, 336.28 ± 291.31, and 539.6 ± 383.13 kg/day, respectively. Economic analyses proved that general hospitals spent 1.63 times more than specialized hospitals on treating hazardous–infectious waste per year. The annual cost of treating each kilogram of hazardous healthcare waste in studied HCWTSS was 0.3 dollars. A range of total annual costs in 43 HCWTSS was limited to 7.9–118 thousand dollars. The results of ANOVA test demonstrated that the age and performance levels of hospitals significantly affect the annual capital and operating costs, respectively. Hence, improving recycling knowledge and increasing source-separated recycling should be considered to control the costs in HCWTSS. The results of this work have implications for the hospital managers in especially developing countries to evaluate previously unknown economic analyses and policies and take action to control wasted costs in HCWTSS.

Effective methods for the decontamination of healthcare waste: Ozone and UV-C radiation process

ABSTRACT Human-generated waste, including infectious healthcare waste, poses significant risks to public health and the environment. The COVID-19 pandemic has increased the global production of infectious waste, emphasizing the need for safe and sustainable waste management practices. While autoclaves are commonly used for on-site disposal, alternative methods like ozone gas and UV-C radiation offer environmentally friendly options that effectively eliminate pathogens without leaving toxic residues. Inadequate waste management can contribute to disease transmission, while open burning releases harmful pollutants. This study investigated the effectiveness of different disinfection agents – ozone gas and UV-C radiation – on infectious solid waste contaminated with bacteria. The bacterial indicators examined were Staphylococcus aureus, Bacillus subtilis, and Pseudomonas aeruginosa. The experimental methods included operating each ozone and UV-C radiation individually and simultaneously using ozone gas and UV-C radiation. The study also investigated exposure times and various concentrations of ozone gas. The findings demonstrated that the simultaneous application of ozone gas and UV-C radiation was the most effective method for decontaminating infectious solid waste and targeting the selected bacteria. The concentration of ozone gas ranged from 165 to 5000 ppm, depending on generation time and treatment chamber volume, while exposure times varied from 1 to 180 minutes. In applying UV-C rays, complete elimination of S. aureus was observed after 60 minutes up to 6-log, while the reduction of B. subtilis and P. aeruginosa were 2-log and 3-log, respectively. Ozone gas had the ability to inactivate all strains, but when ozone gas and UV-C rays were used simultaneously, this process was accelerated and improved. The total reduction in the bacterial load was 8-log. Considering the increase in population and the subsequent increase in waste generation, adopting an environmentally friendly waste management method can be very advantageous. Implications: This study highlights the effectiveness of simultaneously applying ozone gas and UV-C radiation for decontaminating infectious solid waste, offering an environmentally friendly alternative to traditional thermal treatments like autoclave and incineration. By optimizing ozone concentrations and exposure times, this method reduces disease transmission risks and minimizes environmental impact. These findings are crucial, especially during outbreaks such as the COVID-19 pandemic, providing scalable, sustainable waste management solutions for healthcare facilities. Implementing these techniques can protect public health and the environment, setting a new standard for safe infectious waste disposal worldwide, mitigating hazardous pollutants, and reduce the exposure risk of bio-hazardous residues.

GIS-technologies and algorithm for developing regional systems for handling medical waste on the example of three regions

Introduction. GIS is a modern computer technology designed for collecting, storing, analyzing and visualizing spatial data – mapping. GIS is also actively used in healthcare to solve many regional problems, including optimization and management of healthcare resources. Over last decade, many researchers have used mathematical software models for healthcare waste management. A review of the literature shows facility location, risk to the public, and economic feasibility to be among the issues that have been extensively covered in the literature. Designing a reverse logistics network using mathematical software tools is an efficient and effective way to manage healthcare waste. The objective of the study. To determine the optimal approach to creating a functional model of a system for managing medical waste of class B and C using GIS-technologies for each of the three regions, based on the characteristics of each. Materials and methods. Medical institutions in three regions (St. Petersburg, Leningrad Region and Krasnoyarsk Territory) as sources of medical waste generation were considered taking into account their capacity and specialization. The composition and volumes of waste by class were determined using a calculation method based on indicative waste generation standards. The identification of local technologies for the neutralization of medical waste existing in medical institutions was carried out. The obtained data was processed statistically and displayed on electronic maps for subsequent use in GIS technologies, as well as for the development and justification of a waste management system for medical institutions, taking into account the prospects for the development of healthcare. Results. Based on the analysis of data on medical waste of classes B and C in individual medical institutions, as well as an analysis of the power of existing technologies for neutralizing this waste using GIS technologies, proposals were developed to improve the medical waste management system in three regions. The proposals are aimed at improving the sanitary and epidemiological situation in the regions over a five-year period and take into account the features of the existing transport infrastructure and the requirements of sanitary legislation. Limitations. The model of a medical waste management system using GIS technologies was used only for managing waste of classes B and C. Conclusion. To ensure the safe and environmentally sustainable functioning of the waste management system of classes B and C in the regions, it is necessary to apply an integrated approach based on GIS technologies. This approach should take into account the regional characteristics of the management of the medical waste disposal system and its economic feasibility and take into account the regional characteristics of transport logistics and the prospects for the development of healthcare.

Generation and Composition of Medical Waste in Lafia

Background: Effective management of medical waste is a prerequisite for efficient delivery of healthcare services, human health and environmental protection; and the availability of adequate data with regard to medical waste generation and composition is generally considered to be fundamental in the development of efficient medical waste management. However, in Lafia, the state capital of Nasarawa State, Nigeria and a rapidly developing town, there is inadequate information on the medical waste generation and composition. This study thus sets to evaluate the medical waste composition and generation in Lafia by direct observation during both rainy and dry seasons Methodology: The study involved the survey of a cross section of three (3) tertiary health institution. Findings: The study showed that there is significant variation in healthcare waste management practices and sustainability factors (Reduce, Reuse and Recycle) (3Rs). The test showed that there prominent method of healthcare waste management at the studied institution was practice of incineration, pit burning and burying and frequency of waste disposal, leaving out other new and improved technologies for proper waste managements. This study aims to evaluate the medical waste generation and composition in Lafia, Nasarawa State, Nigeria across public and private hospitals. Unique Contribution to Theory, Practice and Policy: It is anticipated that the outcome of this research will avail resourceful data that will be needed for effective hospital waste management and other planning and design works.