Infectious Waste Management Research Articles

EDI&S SO05 Barriers to delivering a net zero NHS: An evaluation of Sustainability in Surgery across the Midlands

Abstract Background The healthcare sector is under increasing scrutiny for contributing approximately 4.6% of the UK’s total carbon footprint and 25% of the public sector’s carbon footprint. With support from the UK Health Alliance on Climate Change, the NHS aims to reach a net zero carbon target by 2045 through its Greener NHS campaign. This study aimed to identify key barriers to implementing sustainable practices in the surgical environment. It involved reviewing Green Plans published by Integrated Care Systems (ICSs) in the Midlands, conducting a thematic analysis of relevant literature, and surveying key stakeholders within NHS Trusts in the Midlands. Method Between June and September 2023, Green Plans from 11 ICSs across the Midlands were evaluated by two reviewers for the inclusion of the "key areas of focus" outlined by the NHS Green Plan Guidance. Additionally, three computerised searches were conducted using Ovid MEDLINE and Embase to retrieve abstracts published before May 2023 on reusable surgical gowns, re-sterilisation of surgical energy devices, and operating theatre waste management. Three reviewers screened the abstracts to identify barriers to implementing change. Based on these findings, a framework was developed for the “Supporting a Greener NHS Survey” and disseminated to key stakeholders in the Midlands. Results A heat map was created to assess compliance of each Green Plan with NHS England guidance (Figure 1). The literature search yielded 82 abstracts and key barriers to sustainability were identified as infection control, cost implications, instrument damage, and waste management practices. The survey received 89 responses; 45% did not use reusable drapes at their Trust, 35% did not use reusable gowns, 46% did not use reusable laparoscopic ports, and 59% didn’t know whether their energy devices were recyclable. Key barriers to implementing sustainable change included surgeon preference, financial constraints, and infection control concerns. Conclusion The literature analysis and survey of stakeholders in the Midlands identified several barriers to implementing sustainable changes. With national, regional and local organisational impetus coupled with clinical leadership commitment to sustainability, these barriers can be overcome with multi-disciplinary involvement. By investing in comprehensive training programmes and implementing rigorous quality control measures with input from infection prevention and control teams, clinical leaders and clinicians are best placed to help overcome these barriers and promote sustainability in the surgical environment.

Study of the economic consequences and phthalate emission caused by centralized and decentralized patterns of infectious waste management

The development of health services of hospitals in developing countries has led to a significant increase in the production of infectious waste, which has important economic and environmental consequences. Therefore, reducing pollutant leakage caused by disinfection and reducing infectious waste management costs are important in achieving sustainable development goals in hospital management. In this study, the centralized and decentralized patterns of infectious waste management were studied in three hospitals in Behbahan, Iran. Economic analysis was done based on the financial model. Phthalate emission from disinfection equipment was measured for investigating the level of exposure to the pollutant in the studied patterns. The results showed that the cost of waste transportation for studied hospitals in the centralized patterns increased by 12.1%. However, reductions in disinfection and transfer costs up to 32.4% were available by increasing the segregation ratio of infectious waste. The average emission of phthalates from disinfection equipment in the studied hospitals was 0.260 ng/kg. But emission of phthalate types was not the same, so that the emission of BEHP, IBP, and DBP was 35.97, 4.90, and 1.55 μg/m3, respectively. Considering the hospital waste reduction plan and increasing the segregation ratio to reduce the costs of the hospital led to economic justification of the centralized pattern of infectious waste management as a safe option.

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...

Designing a resilient reverse network to manage the infectious healthcare waste under uncertainty: A stochastic optimization approach

The global expansion of healthcare facilities has resulted in increased levels of infectious-hazardous waste, posing serious threats to the environment and public health. Existing waste management systems can become overwhelmed during health crises, such as epidemics or natural disasters, exacerbating the problem. This study formulates a mixed-integer linear programming model for developing a resilient infectious waste management reverse network during the outbreak of the COVID-19 pandemic. Health crisis are unpredictable in nature and it is almost impossible to predict their exact behavior. Therefore, in this paper, the uncertainty of ambiguous parameters is considered using a scenario-oriented approach. To make the proposed model resilient, three strategies, including establishing new collection centers, overtime, and cooperation with third-party logistics, are introduced. The results derived from running the developed model in GAMS software using the case study data showed that the active collection center cannot serve the network alone, and to make the network more resilient, the strategy of establishing a new collection center should be selected. The findings validate the model’s utility in designing a resilient waste management network during a health crisis, emphasizing the importance of resilience in infectious healthcare waste management networks.

A Bi-objective location-routing model for the healthcare waste management in the era of logistics 4.0 under uncertainty

The purpose of this study is to apply Industry 4.0-based technologies to improve the management of infectious healthcare waste considering location-routing problem and population risk under uncertainty. To achieve this, a decision support system is developed and implemented utilizing a bi-objective mixed-integer linear programming (MILP) model. The bi-objective MILP model improves the performance of the healthcare waste management by applying Industry 4.0 technologies, including electric autonomous vehicles, information sharing system, internet of things (IoT), Global Navigation Satellite System (GNSS), and RFID-tagged waste bags. We develop a multi-objective solution approach by integrating the lexicographic and TH methods. The validity of the model has been established through its implementation in seven hospitals in the city of Karaj, Iran. The results denoted significant improvements in waste collection efficiency, route optimization, and the reduction of contamination risks.

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

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

Knowledge, Attitude, Actions on the Use of Personal Protective Equipment (PPE), and PPE Facilities and Infrastructure for Infectious Waste Management Workers at Siti Khodijah Hospital, Sepanjang, Sidoarjo

A hospital for type B in Sidoarjo, in the section of infectious waste management, has already implemented the use of Personal Protective Equipment (PPE). However, the use of complete PPE is still lacking. As a result, there was a work accident in 2010 where a worker suffered from a skin infection caused by infectious waste. The aim of this study is to describe the knowledge, attitudes, actions on the use of PPE, and the facilities and infrastructure of PPE among infectious waste management workers at a type B hospital in Sidoarjo in 2023. This research is a descriptive observational study, with a sample population of 10 infectious waste management workers using a total sampling technique. The variables studied are the knowledge, attitudes, actions on the use of PPE, and the facilities and infrastructure of PPE among infectious waste management workers. Data analysis was performed univariately. The results showed that out of 10 people, 8 people (80%) had good knowledge and 2 people (20%) had sufficient knowledge. 7 people (70%) had good attitudes and 3 people (30%) had sufficient attitudes. 4 people (40%) had good actions and 6 people (60%) had sufficient actions. Additionally, 3 people (30%) had good PPE facilities and infrastructure and 7 people (70%) had sufficient PPE facilities and infrastructure. The conclusion obtained from this study is that the knowledge and attitudes of the workers are categorized as good, while the actions of the workers and the PPE facilities and infrastructure are categorized as sufficient. The suggestion is to pay more attention to the availability, completeness, and comfort of the PPE facilities and infrastructure needed by infectious waste management workers, and to conduct research on the use of PPE.

Artificial Intelligence in enhancing sustainable practices for infectious municipal waste classification

This research paper focuses on effective infectious municipal waste management in urban settings, highlighting a dearth of dedicated research in this domain. Unlike general or specific waste types, infectious waste poses distinct health and environmental risks. Leveraging advanced artificial intelligence techniques, we prioritize infectious waste categorization and optimization, integrating metaheuristics into optimization methods to create a robust dual-ensemble framework. Our model, the “Enhanced Artificial Intelligence for Infectious Municipal Waste Classification System,” combines ensemble image segmentation methods and diverse convolutional neural network models. Innovative geometric image augmentation enhances model robustness, diversifies training data, and improves accuracy across waste types. A pivotal aspect is the integration of a reinforcement learning-differential evolution algorithm as a decision fusion strategy, optimizing classification by harmonizing outputs from ensemble methods and convolutional neural network models. Computational results, using a newly collected dataset, demonstrate our model’s accuracy exceeding 96.54% while using the existing solid waste dataset we achieve the accuracy of 97.81%, outperforming advanced approaches by margins ranging from 2.02% to 8.80%. This research significantly advances sustainable waste management, showcasing artificial intelligence’s transformative potential in addressing intricate waste challenges. It establishes a foundational framework prioritizing efficiency, effectiveness, and sustainability for future waste management solutions. Acknowledging the importance of diverse datasets, customization for urban contexts, and practical integration into existing infrastructures, our work contributes to the broader discourse on the role of artificial intelligence in evolving waste management practices.

Global household infectious waste management strategies: a systematic review

Global household infectious waste management strategies: a systematic review

Assessment of Basic Services and Handling of Infectious and Highly Infectious Waste in Health Facilities

Introduction: Safe handling and disposal of medical waste are important aspects of ensuring epidemiological safety of medical activities. Objective: To analyze performance of republican health facilities in rendering basic services for hazardous infectious and highly infectious waste management. Materials and methods: This work is a part of a study of basic water, sanitation, and hygiene services rendered. The materials covered information about medical waste handling and management in 350 health facilities in terms of epidemiological safety. Data were collected from November 2020 to January 2021 using a checklist. Results: In most healthcare facilities (56 %), medical wastes, both infectious and highly infectious, are properly separated into three containers: emergency, infectious, and non-infectious wastes. The most common problems observed were related to labeling or color, and compatibility, with the type of waste in the bins. Health facilities still use open burning or other forms of hazardous disposal (24 %). The process of disposal of hazardous and infectious wastes in healthcare facilities shows that safe waste handling is not ensured by the management. Provision of basic waste management services in the coverage areas is at a low level (in the Districts of Republican Subordination/Dushanbe – 35.8 %, in the Gorno-Badakhshan Autonomous Region, Sughd and Khatlon Regions – 11.1 %, 43.3 %, and 36.4 %, respectively), which requires making urgent decisions and establishing procedures for the safe disposal of sharps and infectious wastes. Conclusion: The study results revealed significant shortcomings and unsafe practices, as well as deviations from the basic level that ensures epidemiological safety in health facilities and protects health of patients and medical personnel.

The effects of perceptions of environmental health risk and environmental risk on sustainable infectious waste management behaviours among citizens in Bangkok, Thailand

This study aims to examine how people's perceived characteristics of environmental risks and environmental health risks, as associated with COVID-19 infectious waste problems, affect their participation in sustainable infectious waste management behaviours (i.e. infectious waste minimization, waste collection awareness, and infectious waste segregation). Questionnaires were conducted with 521 people living in Bangkok, Thailand. Confirmatory factor analysis (CFA) was carried out to validate the study variables, followed by structural equation modelling (SEM) to test how perceived characteristics of environmental risks (perceived ecological threat occurrence to the environment and perceived severity of the threat to the environment), the environmental health risks themselves (perceived ecological threat occurrence to human health and perceived severity of the threat to human health) and socio-economic characteristics influence individuals' sustainable infectious waste management behaviours. The results revealed that perceived ecological threat occurrence to the environment and human health did not statistically affect all types of sustainable infectious waste management behaviours, but perceived severity of the ecological threat to human health significantly affected individuals' infectious waste minimization and segregation. Perceived severity of the ecological threat to the environment only affected infectious waste collection awareness. In addition, the respondents' age and education level positively and significantly affected most types of behaviours, whereas income only had a negative effect on respondents' infectious waste minimization. These results provide implications for the development of communication strategies to motivate people to participate in sustainable infectious waste management behaviours.

Healthcare Workers' Knowledge about the Segregation Process of Infectious Medical Waste Management in a Hospital.

Any hospital's primary goal is to restore human health and save lives through health services provided to patients, but at the same time, hazardous wastes are produced. Inconsistent management of unsafe wastes might cause adverse effects and other issues for workers, the environment, and public health. Segregation is considered the critical stage in successful medical waste management. Mixing hazardous medical waste with non-hazardous medical waste will be avoided by correctly applying practices at the segregation stage. This study aimed to assess personnel's knowledge about infectious medical waste and segregation practices used at six wards in Nicosia General Hospital. An analytical cross-sectional study was conducted, and data were collected through a structured self-administered questionnaire. The Statistical Package of Social Science (SPPS) version 25 was used with a minimum statistical significance of α = 0.05. The study population was nurses, nurse assistants, ward assistants, and cleaners working at the study wards. Out of 191 questionnaires, 82 were received, with a response rate of 42.93%. Most participants were female (72%) and nurses (85.4%). Participants had moderate knowledge about infectious medical waste management and good knowledge regarding segregation practices applied in their ward. Segregation was not carried out as it should have been, since most participants stated that infectious medical waste was mixed with non-hazardous medical waste. The number of correct answers the participants gave regarding the colour-coding of different medical waste categories was 67.5%, and only four answered correctly to all questions. Although participants knew segregation practices and the colour-coding process applied to medical waste, they did not use them satisfactorily. They applied methods regarding segregation without specific training, knowledge and guidance. Due to the issue's importance, training programs must be implemented and performed.

Evaluation of healthcare waste management among health functionaries of Gujarat

Introduction: Health Care Waste (HCW) is generated by various activities in healthcare facilities like hospitals, clinical, research institutions, laboratories, blood banks, etc. HCW is both infectious and hazardous and, unless rendered noninfectious and safe, can prove to be hazardous to people coming in contact with it. Objectives: To assess the Knowledge and Practice regarding HCW Management among health functionaries of districts of Gujarat and its association between the designation and qualification with the Knowledge and Practice score. Methodology: It was an observational and cross-sectional study using pretested, reliable, and valid questionnaire. A sample size of 152 was calculated based on the findings of a pilot study. We have implemented our study in Gujarat, divided into four parts (Saurashtra, Central, South, and North Gujarat). Study sites were selected equally in all four areas. Results: A total of 163 healthcare participants were involved in the study, most respondents were from primary healthcare centers (31.7%), followed by medical college hospitals (14.5%). In our study, Bhavnagar district had the highest number of contributors (21.7%), followed by Morbi district (19.1%). The hospital administrator category had the highest knowledge score, while Infection Control or Waste Management Officer had the highest practice score. MBBS/AYUSH graduates had the highest knowledge and practice scores. It is also apparent that staff nurses had better knowledge and practice scores than ANM. Conclusion: The overall assessment score was good for all health workers. Doctors' better knowledge and practice scores signify qualification's role in BMW management.

ANALYSIS OF INFECTIOUS MEDICAL WASTE MANAGEMENT IMPLICATION ON SUSTAINABLE AGRICULTURE DURING THE COVID-19 PANDEMIC - CASE STUDY OF ŠUMADIJA DISTRICT (REPUBLIC OF SERBIA)

Agriculture is the world’s most important industry. According to the structure, Šumadija district is mainly composed of arable land and gardens, which make up 69%. The increased amount of COVID-19 waste generated from medical activities in rural areas needs to be properly handled due to its contagious, even lethal properties. The aim of this study is an analysis of two drivers through the generation of COVID-19 waste, Central and local treatment site, proposed transport routes, and total cost in Šumadija district. Results showed the economic costs of transportation increased 2.5 times compared to before and after the emergence of the COVID-19 pandemic. Also, the increase in health risk was correlated to the increase in the per capita cost of transportation along the transportation routes. Analyses of human health risks and detailed financial calculations gave a clear insight in infectious waste management possible influence on agriculture.

Improving the Environmental Effects of Nosocomial Infectious Effluents by Using Disposable Suction Liner Bags

Goal: Environmental protection is a key issue, and improper disposal of infectious fluids poses irreparable risks to human health and the environment. Infectious waste is any waste that is generated during a diagnostic process, treatment, or research activities that include biological experiments. The management of infectious waste is as vital as its disposal. therefore, it is necessary to use products such as disposable suction bags that collect infectious fluids and prevent them from spreading to the surrounding environment. In this article, we will investigate the issue of nosocomial infections and the methods of preventing the spread of this infection, as well as the management of infectious waste using the new method (disposable suction liner bag) and the old method (permanent suction canisters). Methods: The study was conducted by the AHP Method model, which is one of the multi-criteria decision-making methods and analyzes the evaluation of parameters quantitatively and qualitatively; also, to use this method and evaluations, Expert Choice software has been used. Results: It is clear in this study that permanent suction canisters cause hospital infections, increase medical centers' costs, and increase hospitals' infectious waste, which costs 10 to 15 times more than other waste due to its infectiousness. Also, the use of disposable suction liner bags not only reduces and controls hospital infections but also reduces the costs of disposal and disposal of infectious waste and treatment of infectious wastes, as well as saving water, electricity, and human resources. Conclusion: The results of this study allow managers and officials of hospitals and medical centers to know which type of suction canisters to use to improve the level of hospital control and to be familiar with the advantages, disadvantages, risks, and environmental risks caused by suction canisters. to make the best decision in this regard.

Adaptive Multi-Objective Algorithm for the Sustainable Electric Vehicle Routing Problem in Medical Waste Management

This paper addresses the complex issue of managing medical waste transportation using electric vehicles, with the goal of minimizing both energy consumption and the risks associated with hazardous waste. A multi-objective mixed-integer linear programming model is introduced, incorporating practical factors such as time windows, partial recharge policy, load-dependent discharge, infection risk, and trips to waste disposal facilities. Our proposed method, a combination of the multi-objective evolutionary algorithm using decomposition (MOEA/D) with adaptive large neighborhood search (ALNS) and local search (LS) techniques, is referred to as MOEA/D-ALNS. This method demonstrates superior performance compared with the non-dominated sorting genetic algorithm, NSGA-II, modified MOEA/D and MOEA/D-LNS in benchmark instances with realistic assumptions. Our experimental results revealed an inverse correlation between energy consumption and risk objectives. Sensitivity analyses showed that eliminating time-window constraints results in more energy-efficient and safer routes while maintaining a slightly lower battery energy level can strike an ideal balance between energy consumption, risk, and battery health. This research contributes to the understanding of infectious medical waste management with its consideration of electric vehicles and waste disposal. It lays a solid foundation for future studies aiming to improve the sustainability and efficiency of medical waste routing practices.

Effectiveness of Preventive Nursing Program for Multidrug-Resistant Organism Transmission: A Quasi-experimental Study

Multidrug-resistant organism infections are a major public health problem. Promoting nurses’ practice in preventing multidrug-resistant infections can reduce hospital transmission. This quasi-experimental study investigated the effectiveness of a preventive nursing program for multidrug-resistant organism transmission. The study was carried out in the Department of Internal Medicine in a tertiary hospital in south Thailand. Participants in this study were registered nurses. Two wards were randomly selected as the experimental ward and two as the control ward, then participants from each ward were purposively selected. Finally, there were 60 participants, n = 31 from the experiment wards and n = 29 from the control wards. The experimental group received a 4-week program, whereas the control group followed the usual practice. Then, the practices in preventing multidrug-resistant organism transmission of the experimental and control groups were assessed 4 and 12 weeks after the program ended. The instruments for data collection included a demographic data form and a preventive practice observation form. Data were analyzed using descriptive statistics and a chi-square test. The results showed that, at 4 and 12 weeks after completion of the program, nurses in the experimental group had a significantly higher proportion of correct practices (hand hygiene, use of personal protective equipment, patient placement, patient transport, patient care equipment management, environmental management, and linen and infectious waste management of multidrug-resistant organism transmission) than before receiving the program and in the control group. The findings suggest that the program effectively improves nurses’ correct practices in preventing multidrug-resistant organism transmission. The program can be applied to promote and support preventive practices among nurses. However, long-term follow-ups with the incidence of multidrug-resistant organism transmission should be further studied. In addition, as this study was conducted with nurses working in the internal medicine wards of a tertiary hospital, it is necessary to evaluate the program's effectiveness with different samples prior to its widerimplementation.

Management of face masks driven by the COVID-19 pandemic, possible implications and proposed policies: A household perspective

Poor management of infectious waste in households poses severe health and environmental threats. This study was conducted in the Kassena-Nankana East Municipality of Ghana to assess the management of waste face masks/PPEs used in the prevention of the spread of the COVID-19 pandemic at the household level. Information was elicited from 150 households and two (2) institutions in charge of waste management to elicit information on the generation, management practices, and challenges in handling waste face masks/PPEs in the area. The study estimates that about 107,322 face masks are used daily in the area. Also, the rate of awareness of COVID-19 was strongly related (p = 0.002) to the generated volume of PPEs wasted. The need for face masks/PPEs as protection against COVID-19 largely influenced the rate of PPE waste generation (p = 0.005). However, the study found that 56% of households faced challenges in handling waste PPEs. Among them, 47% burned PPEs separately, 16% burned them with regular waste, and 27% discarded them with household waste. Improved waste management practices are needed to address these issues. Although there was no significant statistical association between age, gender, or occupation and awareness of face masks, there were some observed differences in awareness levels. The odds of respondents aged 18–25 being aware of face masks were 1.273 times greater than those aged 35 and older, while the odds of respondents aged 26–34 being aware of face masks were 2.181 times greater than those aged 35 and older. However, these differences may not be statistically significant. It is recommended that enhancing waste management procedures and educating people on the proper disposal of waste PPEs will be effective in the management of waste PPEs.

Infectious healthcare waste management among private dental practitioners in the Rabat-Salé-Kénitra region, Morocco: A cross-sectional study on knowledge, attitudes, and practices.

The increase in dental healthcare facilities and the use of single-use equipment have increased the production of healthcare waste. Their mismanagement exposes healthcare workers, waste managers, and the population to an infectious risk and negatively impacts the environment. Therefore, a correct management procedure has to be adopted from separation through storage to disposal. This study aimed to investigate dentists' knowledge, attitudes, and practices regarding managing infectious healthcare waste in private dental offices. A descriptive and analytical cross-sectional survey was conducted between December 2020 and March 2021 among private dentists registered at the Moroccan National Council of Dentists in the Rabat-Salé-Kénitra region. A questionnaire was developed to assess waste management in dental offices. Of the 500 questionnaires distributed, 190 completed and exploitable questionnaires were collected. Only 27.3% of healthcare waste managers in dental practices received training, 21,5% of practitioners assimilated the used gloves into household waste, 71.5% disposed of the waste generated by their offices directly into public bins, and 86.4% were unaware of Moroccan law 28-00 on waste management and disposal. This study highlights dentists' apparent lack of knowledge regarding healthcare waste management, and significant gaps were identified between actual practices and recommended regulations. To address these issues, developing a comprehensive medical waste management plan is crucial to encourage the practical cooperation of all stakeholders in this sector.

PARADIGM OF ENVIRONMENTAL PROTECTION AND MANAGEMENT OF HOUSEHOLD MEDICAL WASTE IN THE COVID-19 PANDEMIC: EXPECTATIONS AND CHALLENGES

The Covid-19 outbreak has had an impact on various sectors of life, including the environment. Medical waste in the community has increased in the new normal era of the Covid-19 pandemic, this can be seen from the existence of new adaptations in society, but in its application, household medical waste management is still an obstacle to this day. The approach method used is juridical-normative, with the type of dogmatic research, a form of perscriptive research on legal relations. The specification of this research is descriptive-analytical, the government continues to make various efforts in handling household medical waste. State responsibility as the basis for the implementation of environmental protection and management is carried out through the enforcement of environmental laws, namely administrative, civil and criminal law enforcement. Formulation of a new policy on the management of Infectious and Household Waste from Handling Covid 19.