Sustainable Healthcare Waste Management Research Articles

Comprehensive Assessment of Pharmaceutical Waste Disposal Practices in Ishaka-Bushenyi Municipality: Implications for Public Health and Environmental Sustainability

Proper management of pharmaceutical waste is crucial for safeguarding public health and the environment. This study aimed to comprehensively assess pharmaceutical waste management practices in hospitals, pharmacies, and households within Bushenyi-Ishaka Municipality, Uganda. The study employed a qualitative case study design, gathering data through observations, interviews, and questionnaires administered to five pharmacies, two hospitals, and 100 households. The results revealed that the mean amount of pharmaceutical waste generated by pharmacies and hospitals in Ishaka was 40.5 kg ± 32.39 kg per month, of which 26.83 kg ± 29.10 kg were disposed of safely. However, 60% of the waste was categorized as hazardous. The study found that while most facilities used labeled or color-coded containers for waste segregation, the practice of segregation was inconsistent, with 71.43% of the facilities not segregating their waste. Incineration (42.86%) and dilution followed by flushing in protected soak pits (42.86%) were the primary disposal methods employed by the facilities. Concerningly, only 4% of households returned unused or expired medications to pharmacies, with the majority disposing of them in dustbins (46%) or flushing them down toilets (41%). The findings also highlighted gaps in awareness and training, with 50% of pharmacy staff not receiving any training on proper pharmaceutical waste disposal, and only 14.29% of the facilities having established waste management guidelines. These deficiencies in knowledge and practices contribute to the suboptimal management of pharmaceutical waste, posing significant risks to public health and the environment. The study underscores the urgent need for comprehensive policies, targeted training programs, and community-based initiatives to enhance pharmaceutical waste management practices in Bushenyi-Ishaka Municipality and similar settings. Addressing these challenges is crucial for mitigating the adverse impacts of improper pharmaceutical waste disposal and promoting sustainable healthcare waste management. Keywords: Pharmaceutical waste, Waste management, Disposal practices, Awareness, Hazardous waste.

Healthcare Waste Management: An Overview

Healthcare waste (HCW) is a vital global issue that cannot be overlooked due to its threat to humans and the environment stemming from its infectious and hazardous nature. This study examines previous works undertaken on healthcare waste management (HCWM) practices around the world, notably the developing countries with a particular interest in segregation, collection, transportation, treatment, and disposal of HCW. This study draws attention to the environmental hazards arising from each stage of HCWM. Factors affecting HCWM practices have also been discussed. This study revealed evidence of poor HCWM practices in many developing countries. It also showed the impacts of human and non-human factors on HCWM practices. Proper documentation, sufficient budget, adequate supply of HCWM materials, frequent training of healthcare workers, and development of local manuals and guides are essential if a country is determined to achieve an efficient and sustainable HCWM system. Liquid HCW needs to be investigated as much as the solid HCW. Exploration of HCW minimization, reuse, and recycling opportunities is recommended for future research. The use of Modern-day technology such as Artificial Intelligence and geographic information system (GIS) has provided good results so far. However, they can be explored further for prediction, real-time monitoring, and reporting of HCW. The present study can be adopted as a guide in discussing issues about HCWM.

Critical success factors for the adoption of circular economy in sustainable healthcare waste management

Critical success factors for the adoption of circular economy in sustainable healthcare waste management

Environmental Sustainability and Waste Management Practices

Background: The study aims to explore environmental sustainability and medical waste management practices in Ghanaian private hospitals in the Greater Accra Region. It also sought to determine if there is any form of collaboration between private hospitals and district assemblies in managing medical wastes. Methods: A qualitative research approach with a cross-sectional study design was used to collect data from employees of the three private hospitals and the district assemblies. A structured interview guide was employed to gather data from 13 purposively selected participants. Results: The findings of the study indicated that there is a collaboration between private hospitals and district assemblies with regard to medical wastes management activities. Conclusions: It is recommended that policies on medical waste management are enforced to ensure sustainable healthcare waste management. Keywords: Environmental sustainability, collaboration, medical waste, private hospitals, district assemblies.

Health Workers' Knowledge and Attitude Towards Healthcare Waste (HCW) Management in the Federal Medical Centre, Umuahia

Purpose: To enhance the management of healthcare waste and prevent injuries and the spread of diseases, healthcare workers must have appropriate knowledge of sustainable Health Care Waste Management (HCWM) techniques. This study assessed the knowledge and the attitude of health professionals in the Federal Medical Centre, Umuahia, towards Health Care Waste Management (HCWM).
 Methodology: A structured questionnaire was used to conduct a cross-sectional survey of 319 participants, yielding 313 responses. 
 Findings: From the result, it was deduced that the health workers’ knowledge of HCWM was satisfactory; 82.7% had knowledge of the World Health Organization (WHO) recommended standards on HCWM. However, the result also showed that 59.40% of the respondents had not received any training on HCWM in recent years. In terms of their attitude, their responses to questions suggest they have a positive mindset towards their role in HCWM. 85.90% of the health workers practised waste collection by utilizing colour-coded containers and plastic bags. The utilization of other segregation methods was measured, recording mean exceeding the acceptable mean score of 2.5 except for coloured-coded containers (2.08) and plastic bags (2.05). The practice of self-protection from risk was evaluated by determining respondents’ use of personal protective equipment (PPE) during waste handling. The recommended PPEs were always in use, excluding the safety goggles.
 Unique contribution to theory, practice and policy: The study calls for continuous supportive supervision and capacity building (training) among the health workers to ensure effective HCW practice and sustainability. The hospital administration needs to enforce strict biomedical waste management regulations.

Healthcare waste management processes and transition towards a circular economy

Abstract The new Waste Directive 2018/851/EU strengthens the role of waste prevention and emphasizes recycling to facilitate the transition to a circular economy. So far, it has not been legislatively necessary for the Czech Republic to look at waste from a broader perspective, especially in healthcare, where the waste management is perceived as a separate process suitable for outsourcing. With the new directive and the transition to a circular economy, the waste management process becomes part of strategic management processes. These processes are partially systematically covered by the standards of the environmental management system, used mainly in the industrial sector. The optimal solution is a reassessment of the entire waste management of the medical facility and the inclusion of the principle of waste prevention in the decision to purchase a product or service. The necessary condition for the successful implementation of the circular economy is to minimize negative impacts on health and the environment while maintaining the economic sustainability of such a solution. Setting up generally sustainable management of medical facilities thus goes beyond current clinical practice. The health technology assessment model provides several domains that complement life cycle analysis and health impact assessment, including a health risk assessment method. The outputs of the above analyzes and evaluations cover the maximum scope of public interest in healthcare. A practical approach is developing a system of methodologies based on the methods mentioned above, which respect the whole chain of strategic processes of healthcare facilities and involve maximum stakeholders in the evaluation process. We test the approach on a pilot facility in the project SS01010276 ‘Sustainable healthcare waste management: economically feasible minimization of impacts on health and environment' supported by the Technology Agency of the Czech Republic within the Environment for Life Program. Key messages The approach aims to add value to traditional waste management approaches and integrate the long-term interests of key stakeholders using the overlapping outcomes of respective assessments. A sustainable approach to healthcare waste management must be developed with the involvement of all key stakeholders and concerning their interests within their position in the assessment process.

Potential for improving routine immunisation waste management using measles vaccination campaign 2017 in Kebbi State, Nigeria

BackgroundImmunisation activities generate sharps and infectious non-sharp waste that have harmful impact on the community and health care workers if disposed of improperly, leading to carbon mono oxide (CO) emissions which contribute to global warming. Health care waste is not effectively managed, especially in some developing countries. However, measles supplemental immunisation activities (SIAs) are used to strengthen routine immunisation system, including waste management. The waste management planning provides an opportunity to build capacity, mobilize resources and strengthen structures to ensure continual disposal of routine immunisation waste. MethodsWe reviewed the Kebbi State and LGA routine immunisation waste management situation and identified existing gaps; developed and implemented the plan for waste management, including strengthening routine immunisation waste management. The process included, reactivation of measles technical coordination committee, mobilizing resources for funding, and sustenance of immunisation waste management. The health care workforce was trained in safe immunisation waste disposal practices. ResultsImmunisation waste management committee and the structure was established and strengthened at the state and LGA levels and a total cost of 11,710.70 USD was expended on injection waste management, with an average cost per injection of 0.01 USD. A total of 11,829 safety boxes were incinerated in the state, including those generated from routine immunisation sessions. Twenty-one Local Immunisation Officers, 1097 and 2192 team supervisors and healthcare worker vaccinators respectively were trained on immunisation waste disposal. ConclusionImmunisation waste management strategies protect healthcare workers and reduce the adverse impact on the environment. Improving key areas such as human and financial resources ensures accountability towards sustainable healthcare waste management.

Framework for PESTEL dimensions of sustainable healthcare waste management: Learnings from COVID-19 outbreak

The COVID-19 pandemic has put the world economy at an unprecedented position and protecting society from the infection is at the core of all measures. As the COVID-19 virus stays longer on plastic and stainless steel materials, hence the healthcare wastes (HCW), coming out of the treatment of COVID-19 infected patients can be one of the potential route for transmission of infection. Therefore, the present study analyses the dimensions of sustainable HCWM by using a multi-method approach: PESTEL (political, economic, social, technological, environmental and legal) analysis, TISM (total interpretive structural modeling) and fuzzy- MICMAC (cross-impact matrix multiplication applied to classification) analysis. The opted research framework yields 17 PESTEL dimensions of sustainable HCWM during the COVID-19 outbreak through the literature survey and experts’ discussions. Then, the TISM methodology developed a hierarchical digraph of all the 17 dimensions of sustainable HCWM based on the interrelationships. Fuzzy-MICMAC analysis classified all 17 PESTEL dimensions into four groups depending upon their driving and dependence powers. The study concluded that the policy framework for targeting political, legal and environmental issues should be the immediate concern of the worldwide governments and health officials. The effluent control and compliance to environmental laws being the output dimensions should be tracked regularly for ensuring the cleaner production in healthcare services. The PESTEL analysis will help the hospitals’ managers and policymakers to understand the macro-environment surrounding the HCWM.

Attitude of intern doctors and B.Sc. nursing students regarding various aspects of biomedical waste (management and handling) rules: a cross sectional study

Background: Different types of waste are generated during healthcare activities. The waste so generated has chance of causing serious infection and also injury to persons who come in contact with it whether the contact is direct or indirect. Safe and sustainable health care waste management is not possible without a favourable attitude among health care providers. The objective of the study was to assess the attitude of Intern doctors and B.Sc. nursing students: the future health care providers, regarding various aspects of Biomedical Waste (Management and handling) Rules. Methods: This was a cross-sectional study. The study was conducted amongst Intern doctors and B.Sc. nursing students posted at Prince Bijay Singh Memorial (PBM) and associated group of hospitals attached to Sardar Patel Medical College, Bikaner. Results: In the study out of 204 respondents, 54.4% were B.Sc. nursing students and 45.6% were intern doctors. Statistically significant difference was seen in overall attitude of study population belonging to different professional group regarding biomedical waste management. Overall the attitude of study group was favourable. Conclusions: Favourable attitude of health care workers will go a long way in better implementation of biomedical waste management rules and thereby help in decreasing adverse health effects of improper waste handling.

A review of sustainable facilities management knowledge and practice

Sustainability is seen as a far-reaching issue now, and one which the facilities management [FM] profession cannot overlook. This paper explores current sustainable facilities management [SFM] knowledge and practice with specific focus on performance as part of a research focus toward proposing a sustainable FM performance management framework for sustainable healthcare waste management in Malaysia. This paper utilized a review of extant literature on the subject of SFM, FM performance and FM development in Malaysia as source of information. Findings reflect the increasing recognition of the need for the strategic FM function, and how facilities managers are best positioned to drive organizations’ sustainability agendas. In Malaysian context, this recognition is barely evident as findings show FM practice is still immature and predominantly operational. Unlike developed FM markets, FM relevance in Malaysia is being driven by the public sector. Also findings show a disharmony between organizations’ sustainability priority areas and the responsibilities for facilities managers to execute them where the sustainability policy of organizations prioritize one FM service and the facilities managers’ responsibilities prioritize another. As most of SFM implementation is driven by legislation this seems to strengthen the position that, organizations continue to view support services as non-value-adding, as unavoidable liabilities. The implication of this is the pressure on the FM function to continually express its strategic relevance to organizations by tangible value-adding performance output. This creates a new perspective to measuring and managing facilities performance. This paper therefore elevates the importance of FM performance management in SFM context taking into account the peculiar position of the facilities manager. This is seen as a way forward for FM to better express its value to the organization

Emergency medical services (EMS) and waste: a review of the literature on sustainable EMS waste management

Waste management contributes significantly to the financial costs and carbon footprints of healthcare organisations, thus contributing to climate change and subsequent harm to health. Increasing efficiencies and the introduction of sustainable waste management practice within healthcare organisations, including emergency medical services (EMS), could reduce associated CO2 and other greenhouse gas emissions while reducing costs, enabling funding to be reinvested in patient care. This article aims to contribute to the discussion of sustainable healthcare waste management, particularly within EMS, and provides a review of the literature on this topic. The literature suggests there is a growing interest among EMS in the efficient use of resources and there has been some gradual change in practice, including the introduction of sustainable waste management practices. The literature also reveals that empirical research discussing greenhouse gas emissions associated with EMS is limited, particularly in regard to waste management. The evidence indicates that there is scope for further research investigating the environmental impacts of EMS. Such research could specifically investigate the CO2 emissions associated with EMS waste management and interventions that might reduce these emissions, with the potential sequelae of cost savings or income generation.

Healthcare waste management in Botswana: storage, collection, treatment and disposal system

Healthcare waste management has become a major issue of concern for solid waste managers due the treatment of healthcare waste being generated and the potential environmental risks and public health risks to those who come in contact with it. Special attention must be paid when dealing with healthcare waste because of infectious and non-infectious waste as well as general waste it contains. If managed through inappropriate healthcare waste management systems, it can adversely affect the environment and public health. In Botswana, the Waste Management Act was introduced in 1998 not only for healthcare waste handling, but also to promote sustainable treatment and disposal; the document currently applies to the management of all the healthcare waste, including liquid and chemical waste. The paper presents an overview of the current healthcare waste management in Botswana. A mixed methods study incorporating an exploratory survey was used. A range of data gathering techniques including observations, informal dialogues, published and grey literature and semi-structured interviews of selected participants and operatives dealing with waste were used to identify key policies, composition, storage, treatment, disposal, challenges and best practices. Specifically, sorting and storage, collection, treatment and disposal systems and the recent regulation of healthcare waste were discussed. Current storage facilities and collection services in the healthcare facilities (HCFs) were not operating effectively and efficiently. The composition was almost the same in the HCFs, with mean values in the following decreasing order: general waste (48.84) >medical waste (39.39 %) >sharps (13.13 %). Therefore, more attention should be paid on segregation of infectious and non-infectious from general waste, pollution prevention and recovery of valuable materials from HCFs. Several suggestions were made to deal with healthcare waste management problems efficiently and to prevent the potential impacts. These included development of a legislation to allow for a more defined roles and responsibilities for healthcare personnel responsible for the handling and disposal of the waste streams at the point of generation in the HCFs. Therefore, there is an urgent need to formulate a more sustainable healthcare waste management system.

Going toward Green Hospital by Sustainable Healthcare Waste Management: Segregation, Treatment and Safe Disposal

Hospitals have always been the focal point of social systems identity. Thus, they acte as the mirror of the community and should be responsible for it. Hospitals have been recognized as a significant source of contamination all around the world, therefore helping to endanger public health on an unintentional process. Although, the main mission of the hospital is to promote human health, it cannot be assumed as an island apart from its urban environment. “Green Hospital”, as an approach to address environmental challenges and to meet communities need in health issues, has emerged recently as a try to improve the health, in line with its main mission. In this approach, all the environmental aspects of waste management are important and to be addressed. Hospitals’ administrators can manage wastes disposal through composting, recycling and better supplying methods (downsizing packaging, using reusable products instead of disposables and using recycled products). This article is a review of the subject matter, in nature, using many library and online sources; it discusses about the need to move towards the green hospital approach, the administration and leadership role in its establishment, the environmental impact of hospital operations and assessment of the effects, wastes management and control, and also the methods in wastes disposal and treatment.

Sustainable healthcare waste management: a qualitative investigation of its feasibility within a county in the south west of England

This paper aims to investigate the possibility of safely and lawfully employing a sustainable reduce, reuse, recycle philosophy in the management of waste within healthcare settings. Climate change presents significant threats to our wellbeing on a global scale and provides a new challenge for healthcare organisations. As the United Kingdom’s biggest public sector employer, the National Health Service has enormous power to mitigate the impact of climate change by implementing sustainable practices. One area in which sustainable practices could be employed is within healthcare waste management. The investigation used a qualitative approach using semi-structured interviews with 20 participants responsible for the safe management of healthcare waste in an English county. Interviews indicated that topics such as knowledge, the environment, finance and legislation influence attitudes and behaviour in healthcare waste management. Participants were clear that from financial and environmental perspectives an aim to reduce, reuse and recycle waste in health care was desirable. Attempts to implement sustainable healthcare waste management practices, informed by a sustainable waste management philosophy are desirable both financially and environmentally. Research is needed to explore behaviour, attitudes, learning, knowledge and the role of the environment in healthcare waste management.

Health care waste management in Cameroon: A case study from the Southwestern Region

Healthcare waste streams are persistent waste streams and which are consistently increasing in volume and complexity in developed and developing countries. When poorly managed, through inappropriate health care waste management systems, they can cause adverse effects to human health and the environment. This paper presents an evaluation of health care waste management systems in Cameroon, based on a survey of five health care facilities in the Southwestern Region of Cameroon. It is established that health care waste collection and handling systems including containers and bins for segregated wastes are generally in a poor state. A proportion of the waste stream is disposed of in open dumps in combination with municipal solid wastes while some are disposed of in incinerators which are often poorly designed. The waste stream is complex and heterogeneous with an average waste generation rate estimated at 44.9 kg/day equivalent to over 16 tonnes/annum comprising 49%, 16% and 14% of general, infectious and sharps respectively for a typical Health Care Facility in Buea which is a medium densely populated town. There is the potential to recover materials from this waste stream, if adequate waste management systems are developed and implemented. Separately recovering the uncontaminated general waste stream for a secondary market ultimately contributes to resource efficiencies and conservation of scarce natural resources. Reducing the waste quantities being incinerated results in less potential for persistent organic pollutants (POPs) and greenhouse gases to be released into the environment, thus contributing to global environmental benefits through climate change mitigation and pollution reduction. The study establishes that the little attention given to medical waste management results from a lack of an integrated approach to policy making at the highest level of decision-making. There is the need for legislation to allow for a more defined roles and responsibilities for health care personnel responsible for the handling and disposal of the waste streams at the point of generation in the health care facilities. Overall, there is the need to formulate more sustainable health care waste management legislation.