Medical waste management in China: A case study of Nanjing

Medical waste management is of great importance due to its infectious and hazardous nature that can cause undesirable effects on humans and the environment. The objective of this study was to analyze and evaluate the present status of medical waste management in the light of medical waste control regulations in Nanjing. A comprehensive inspection survey was conducted for 15 hospitals, 3 disposal companies and 200 patients. Field visits and a questionnaire survey method were implemented to collect information regarding different medical waste management aspects, including medical waste generation, segregation and collection, storage, training and education, transportation, disposal, and public awareness.The results indicated that the medical waste generation rate ranges from 0.5 to 0.8 kg/bed day with a weighted average of 0.68 kg/bed day. The segregated collection of various types of medical waste has been conducted in 73% of the hospitals, but 20% of the hospitals still use unqualified staff for medical waste collection, and 93.3% of the hospitals have temporary storage areas. Additionally, 93.3% of the hospitals have provided training for staff; however, only 20% of the hospitals have ongoing training and education. It was found that the centralized disposal system has been constructed based on incineration technology, and the disposal cost of medical waste is about 580 US$/ton. The results also suggested that there is not sufficient public understanding of medical waste management, and 77% of respondents think medical waste management is an important factor in selecting hospital services.The problematic areas of medical waste management in Nanjing are addressed by proposing some recommendations that will ensure that potential health and environmental risks of medical waste are minimized.     

Municipal solid waste characteristics and management in Allahabad, India

Increasing population levels, rapid economic growth and rise in community living standard accelerates the generation rate of municipal solid waste (MSW) in Indian cities. Improper management of MSW causes hazards to inhabitants. The objectives of the study are to determine the quantitative and qualitative characteristics of MSW along with basic information and to create GIS maps for Allahabad city. The samples have been randomly collected from various locations and analyzed to determine the characteristics of MSW. A questionnaire survey has been carried out to collect data from inhabitants including MSW quantity, collection frequency, satisfaction level, etc. The Geographic Information System (GIS) has been used to analyze existing maps and data, to digitize the existing sanitary ward boundaries and to enter the data about the wards and disposal sites. The total quantity of MSW has been reported as 500 ton/day, and the average generation rate of MSW has been estimated at 0.39 kg/capita/day. The generated ArcGis maps give efficient information concerning static and dynamic parameters of the municipal solid waste management (MSWM) problem such as the generation rate of MSW in different wards, collection point locations, MSW transport means and their routes, and the number of disposal sites and their attributes.     

Biomedical solid waste management in an Indian hospital: a case study

The objectives of this study were: (i) to assess the waste handling and treatment system of hospital bio-medical solid waste and its mandatory compliance with Regulatory Notifications for Bio-medical Waste (Management and Handling) Rules, 1998, under the Environment (Protection Act 1986), Ministry of Environment and Forestry, Govt. of India, at the chosen KLE Society's J. N. Hospital and Medical Research Center, Belgaum, India and (ii) to quantitatively estimate the amount of non-infectious and infectious waste generated in different wards/sections. During the study, it was observed that: (i) the personnel working under the occupier (who has control over the institution to take all steps to ensure biomedical waste is handled without any adverse effects to human health and the environment) were trained to take adequate precautionary measures in handling these bio-hazardous waste materials, (ii) the process of segregation, collection, transport, storage and final disposal of infectious waste was done in compliance with the Standard Procedures, (iii) the final disposal was by incineration in accordance to EPA Rules 1998, (iv) the non-infectious waste was collected separately in different containers and treated as general waste, and (v) on an average about 520 kg of non-infectious and 101 kg of infectious waste is generated per day (about 2.31 kg per day per bed, gross weight comprising both infectious and non-infectious waste). This hospital also extends its facility to the neighboring clinics and hospitals by treating their produced waste for incineration.     

Report: Treatment of medical waste in Nisava and Toplica districts, Serbia

If there are no clearly defined management procedures, medical waste may represent a source of serious health hazards. Medical waste management was evaluated at the three hospitals in the Nisava and Toplica district, in Serbia. All the stages of existing waste management (segregation, collection, storage, transportation and disposal of waste) were examined by interviewing the personnel involved in the management of waste. The generated waste was a mixture of hazardous and non-hazardous waste. The study found that waste management performance in this district was poor and that there were problems in every stage of management. The results indicate that the waste generation rate was 1.92 kg bed(-1) day(-1) and consisted of 98.7% general waste and 1.3% sharps. Inappropriate segregation practices were the biggest problem and led to increased quantities of general waste. There were no specific regulations for the segregation of the medical waste. None of the surveyed hospitals have a system to refine wastewater and there were no training courses about hospital waste management.     

Overview of biomedical waste management in selected Governorates in Egypt: a pilot study

Inadequate management of biomedical waste can be associated with risks to healthcare workers, patients, communities and their environment. This study was conducted to assess the handling and treatment of biomedical waste in different healthcare settings in Egypt. Five hospitals and ten primary healthcare settings were surveyed using a modified survey questionnaire for waste management. This questionnaire was obtained from the World Health Organization (WHO), with the aim of assessing the processing systems for biomedical waste disposal. Researchers found that biomedical waste is inadequately processed in hospitals and primary healthcare settings due to the absence of written policies and protocols. Accordingly, healthcare staff, patients, the community and the environment may be negatively affected by exposure to the hazards of biomedical waste. The development of waste management policies, plans, and protocols are strongly recommended, in addition to establishing training programs on proper waste management for all healthcare workers.     

Medical waste management in Ibadan, Nigeria: obstacles and prospects

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

Web-GIS oriented systems viability for municipal solid waste selective collection optimization in developed and transient economies

Municipal solid waste management is a multidisciplinary activity that includes generation, source separation, storage, collection, transfer and transport, processing and recovery, and, last but not least, disposal. The optimization of waste collection, through source separation, is compulsory where a landfill based management must be overcome. In this paper, a few aspects related to the implementation of a Web-GIS based system are analyzed. This approach is critically analyzed referring to the experience of two Italian case studies and two additional extra-European case studies. The first case is one of the best examples of selective collection optimization in Italy. The obtained efficiency is very high: 80% of waste is source separated for recycling purposes. In the second reference case, the local administration is going to be faced with the optimization of waste collection through Web-GIS oriented technologies for the first time. The starting scenario is far from an optimized management of municipal solid waste. The last two case studies concern pilot experiences in China and Malaysia. Each step of the Web-GIS oriented strategy is comparatively discussed referring to typical scenarios of developed and transient economies. The main result is that transient economies are ready to move toward Web oriented tools for MSW management, but this opportunity is not yet well exploited in the sector.     

Source separation of household waste: a case study in China

A pilot program concerning source separation of household waste was launched in Hangzhou, capital city of Zhejiang province, China. Detailed investigations on the composition and properties of household waste in the experimental communities revealed that high water content and high percentage of food waste are the main limiting factors in the recovery of recyclables, especially paper from household waste, and the main contributors to the high cost and low efficiency of waste disposal. On the basis of the investigation, a novel source separation method, according to which household waste was classified as food waste, dry waste and harmful waste, was proposed and performed in four selected communities. In addition, a corresponding household waste management system that involves all stakeholders, a recovery system and a mechanical dehydration system for food waste were constituted to promote source separation activity. Performances and the questionnaire survey results showed that the active support and investment of a real estate company and a community residential committee play important roles in enhancing public participation and awareness of the importance of waste source separation. In comparison with the conventional mixed collection and transportation system of household waste, the established source separation and management system is cost-effective. It could be extended to the entire city and used by other cities in China as a source of reference.     

Environmental assessment of alternative municipal solid waste management strategies. A Spanish case study

The aim of this study is to compare, from an environmental point of view, different alternatives for the management of municipal solid waste generated in the town of Castellón de la Plana (Spain). This town currently produces 207 ton of waste per day and the waste management system employed today involves the collection of paper/cardboard, glass and light packaging from materials banks and of rest waste at street-side containers.The proposed alternative scenarios were based on a combination of the following elements: selective collection targets to be accomplished by the year 2015 as specified in the Spanish National Waste Plan (assuming they are reached to an extent of 50% and 100%), different collection models implemented nationally, and diverse treatments of both the separated biodegradable fraction and the rest waste to be disposed of on landfills.This resulted in 24 scenarios, whose environmental behaviour was studied by applying the life cycle assessment methodology. In accordance with the ISO 14040-44 (2006) standard, an inventory model was developed for the following stages of the waste management life cycle: pre-collection (bags and containers), collection, transport, pre-treatment (waste separation) and treatment/disposal (recycling, composting, biogasification + composting, landfill with/without energy recovery). Environmental indicators were obtained for different impact categories, which made it possible to identify the key variables in the waste management system and the scenario that offers the best environmental behaviour. Finally, a sensitivity analysis was used to test some of the assumptions made in the initial life cycle inventory model.     

Integrated solid waste management based on the 3R approach

Integrated solid waste management (ISWM) based on the 3R approach (reduce, reuse, and recycle) is aimed at optimizing the management of solid waste from all the waste-generating sectors (municipal, construction and demolition, industrial, urban agriculture, and healthcare facilities) and involving all the stakeholders (waste generators, service providers, regulators, government, and community/neighborhoods). This article discusses the concept of solid waste management (SWM). Initially, SWM was aimed at reducing the risks to public health, and later the environmental aspect also became an important focus of SWM. Recently, another dimension is becoming a critical factor for SWM, i.e., resource conservation and resource recovery. Hence, the 3R approach is becoming a guiding factor for SWM. On the one hand, 3R helps to minimize the amount of waste from generation to disposal, thus managing the waste more effectively and minimizing the public health and environmental risks associated with it. On the other hand, resource recovery is maximized at all stages of SWM. Lately, the new concept of ISWM has been introduced to streamline all the stages of waste management, i.e., source separation, collection and transportation, transfer stations and material recovery, treatment and resource recovery, and final disposal. It was originally targeted at municipal solid waste management (MSWM), but now the United Nations Environment Programme (UNEP) is promoting this concept to cover all waste generating sectors to optimize the level of material and resource recovery for recycling as well as to improve the efficiency of waste management services. The ISWM concept is being transformed into ISWM systems to replace conventional SWM systems. This article further discusses the implementation process for ISWM. The process includes a baseline study on the characterization and quantification of waste for all waste generating sectors within a city, assessment of current waste management systems and practices, target setting for ISWM, identification of issues of concern and suggestions from stakeholders, development of a draft ISWM plan, preparation of an implementation strategy, and establishment of a monitoring and feedback system. UNEP is assisting member countries and their cities to develop an ISWM plan covering all the waste generating sectors within a specific geographical or administrative area such as a city or municipality. This umbrella approach is useful to generate sufficient volumes of recycling materials required to make recycling industries feasible. This is also helpful for efficient reallocation of resources for SWM such as collection vehicles, transfer stations, treatment plants, and disposal sites. UNEP is assisting cities to develop and implement ISWM based on the 3R approach. These experiences could be useful for other countries to develop and implement ISWM to achieve improved public health, better environmental protection, and resource conservation and resource recovery.     

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.     

A systems analysis tool for construction and demolition wastes management

Managing construction and demolition (C&D) wastes has challenged many municipalities with diminishing waste disposal capacity. Facing such challenges, the Massachusetts Department of Environmental Protection proposed a policy restricting the landfill disposal of certain C&D waste materials, if unprocessed. This research is to study the potential economic impact of such restriction on construction contractors and C&D waste processors. A spreadsheet-based systems analysis model has been developed to assist the cost-benefit evaluation for various C&D waste management scenarios. The model, developed based on the mass balance principle, is designed to track a C&D waste stream through the various stages of a waste management system, i.e. generation, source separation, processing, recycling, and final disposal. This model, by incorporating the material flow data with the cost/revenue data associated with each management activity, can then provide an economic analysis for a proposed C&D waste management scenario. A case study illustrating the application of this model for Massachusetts is also presented.     

Medical waste management in Turkey: A case study of Istanbul

The objective of this study was to analyze the present status of medical waste management in the light of the Medical Waste Control Regulation (MWCR) in Istanbul, the largest city in Turkey. About 17% of the hospitals, 20% of bed capacity, and 54% of private hospitals in Turkey are located in Istanbul. The first regulation about medical waste management in Turkey was published in 1993, and as a candidate state, it was changed in 2005 in accordance with EU Environmental Directives. In this work, a survey of 14 questions about the amount, collection, and temporary storage of medical wastes was applied to 192 hospitals in Istanbul through face-to-face interviews. It was found that the estimated quantity of medical waste from the hospitals is about 22tons/day and the average generation rate is 0.63kg/bed-day. Recyclable materials are collected separately at a rate of 83%. Separate collection of different types of wastes is consistently practiced, but 25% of the hospitals still use inappropriate containers for medical waste collection. Almost 77% of the hospitals use appropriate equipment for the medical waste collection personnel. The percentage of the hospitals that have temporary storage depots is 63%. Medical waste management in Istanbul is carried out by applying the MWCR.     

Risk management for outsourcing biomedical waste disposal – Using the failure mode and effects analysis

Using the failure mode and effects analysis, this study examined biomedical waste companies through risk assessment. Moreover, it evaluated the supervisors of biomedical waste units in hospitals, and factors relating to the outsourcing risk assessment of biomedical waste in hospitals by referring to waste disposal acts. An expert questionnaire survey was conducted on the personnel involved in waste disposal units in hospitals, in order to identify important factors relating to the outsourcing risk of biomedical waste in hospitals. This study calculated the risk priority number (RPN) and selected items with an RPN value higher than 80 for improvement. These items included “availability of freezing devices”, “availability of containers for sharp items”, “disposal frequency”, “disposal volume”, “disposal method”, “vehicles meeting the regulations”, and “declaration of three lists”. This study also aimed to identify important selection factors of biomedical waste disposal companies by hospitals in terms of risk. These findings can serve as references for hospitals in the selection of outsourcing companies for biomedical waste disposal.     

Hospital solid waste management practices in Limpopo Province, South Africa: a case study of two hospitals

The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%)>medical waste (30.32%)>sharps (8.94%). The mean generation rates were found to be 0.60kg per patient per day.     

The effectiveness of recycling policy options: Waste diversion or just diversions?

Recycling is becoming ever more important as waste generation rates increase globally. Policy-makers must decide which recycling practices to implement from the host of options at their disposal to best divert waste from landfill. This study strived to determine the most important characteristics in recycling programs that were associated with higher material recovery rates, including bag limits, user pay programs, the number of materials collected, curbside collection frequency, promotion and education (P&E) activities, Best Practice principles, and the type of recycling collection stream. Data collected from 223 recycling programs in Ontario during 2005–2010 were used to perform multiple regression analyses. The findings of this study suggest that attributes of convenience are more important to encourage recycling than those that penalize disposal, thus providing important implications for waste policy-makers, both in Ontario and in other jurisdictions.     

Report: Healthcare waste characterization in Chittagong Medical College Hospital, Bangladesh

Healthcare waste management (HCWM) options are inconsistent in Bangladesh. One of the first critical steps in the process of developing a reliable waste management plan requires a comprehensive understanding of the quantities and characteristics of the waste that needs to be managed. This study took into consideration both the quantity and quality of the generated waste to determine the generation rates and physical properties of healthcare waste (HCW) in Chittagong Medical College Hospital (CMCH) and also to estimate the amount of infectious and non-infectious waste generated in different wards. CMCH, the second largest hospital in Bangladesh, comprises 34 wards, 12 of which were selected randomly. Waste materials were collected from these wards and then segregated and weighed. Waste generation per day was found to be 73.22 kg/ward, 1.28 kg/bed and 0.57 kg/patient. A total of 2490 kg of HCW was produced each day in CMCH (37% being infectious and the rest being non-infectious waste). Infectious waste was 27.07 kg per ward, 0.47 kg per bed and 0.21 kg per patient and the non-infectious waste was 46.15 kg per ward, 0.81 kg per bed and 0.36 kg per patient per day. HCW comprised eight categories of waste materials with vegetable/food waste being the largest component (50.21%) and varied significantly (P < 0.05) among the 12 different wards studied. The greatest amount of HCW was recorded (154 kg) in Orthopaedics followed by 96.66 kg in the Medicine Unit-3 and the smallest amount was recorded in Casualty (8.79 kg). The amount of HCW was positively correlated with the number of occupied beds (rxy = 0.79, P < 0.01). There is no structured form of medical waste treatment in CMCH and most waste materials are dumped in open areas for natural degradation or re-sold by scavengers. It is essential to develop a national policy and implement a comprehensive action plan for HCWM that will provide environmentally sound technological measures to improve HCWM in Bangladesh.     

Selection of infectious medical waste disposal firms by using the analytic hierarchy process and sensitivity analysis

While Taiwanese hospitals dispose of large amounts of medical waste to ensure sanitation and personal hygiene, doing so inefficiently creates potential environmental hazards and increases operational expenses. However, hospitals lack objective criteria to select the most appropriate waste disposal firm and evaluate its performance, instead relying on their own subjective judgment and previous experiences. Therefore, this work presents an analytic hierarchy process (AHP) method to objectively select medical waste disposal firms based on the results of interviews with experts in the field, thus reducing overhead costs and enhancing medical waste management. An appropriate weight criterion based on AHP is derived to assess the effectiveness of medical waste disposal firms. The proposed AHP-based method offers a more efficient and precise means of selecting medical waste firms than subjective assessment methods do, thus reducing the potential risks for hospitals. Analysis results indicate that the medical sector selects the most appropriate infectious medical waste disposal firm based on the following rank: matching degree, contractor's qualifications, contractor's service capability, contractor's equipment and economic factors. By providing hospitals with an effective means of evaluating medical waste disposal firms, the proposed AHP method can reduce overhead costs and enable medical waste management to understand the market demand in the health sector. Moreover, performed through use of Expert Choice software, sensitivity analysis can survey the criterion weight of the degree of influence with an alternative hierarchy.     

Solid waste collection and recycling in Nibong Tebal, Penang, Malaysia: a case study.

The implementation of a suitable solid waste management programme with appropriate methods of recycling as an inherent element is vital to the alleviation of the problems associated with solid waste generation, handling and disposal, environmental conservation, public hygiene, etc. The present work is a case study on solid waste collection and recycling practices in Nibong Tebal town, Penang, Malaysia. The amount and types of domestic waste generated, household participation in recycling, identification of existing problems related to the implementation of the recycling programme, etc. formed the basis of this study. Surveys (interviews/questionnaires) and on-site observations were conducted to gather information on the solid waste collection and recycling practice of the residents. A focus group of 60 individuals was selected and their response to a questionnaire, prepared according to a Likert scale, was obtained and analysed. The majority of the respondents expressed concerns about recycling and wanted more to be done in this regard. Illegal collection, aesthetically displeasing sites and a lack of public awareness were problems of major concern. Issues related to inadequate funding and manpower as well as end market are also addressed and suggestions made.     

Management of hazardous waste in Thailand: present situation and future prospects

 This paper deals with the present scenario of hazardous waste management practices in Thailand, and gives some insights into future prospects. Industrialization in Thailand has systematically increased the generation of hazardous waste. The total hazardous waste generated in 2001 was 1.65 million tons. It is estimated that over 300 million kg/year of hazardous waste is generated from nonindustrial, community sources (e.g., batteries, fluorescent lamps, cleansing chemicals, pesticides). No special facilities are available for handling these wastes. There are neither well-established systems for separation, storage, collection, and transportation, nor the effective enforcement of regulations related to hazardous wastes management generated from industrial or nonindustrial sectors. Therefore, because of a lack of treatment and disposal facilities, these wastes find their way into municipal wastewaters, public landfills, nearby dump sites, or waterways, raising serious environmental concern. Furthermore, Thailand does not have an integrated regulatory framework regarding the monitoring and management of hazardous materials and wastes. In addition to the absence of a national definition of hazardous wastes, limited funding has caused significant impediments to the effective management of hazardous waste. Thus, current waste management practices in Thailand present significant potential hazards to humans and the environment. The challenging issues of hazardous waste management in Thailand are not only related to a scarcity of financial resources (required for treatment and disposal facilities), but also to the fact that there has been no development of appropriate technology following the principles of waste minimization and sustainable development. A holistic approach to achieving effective hazardous waste management that integrates the efforts of all sectors, government, private, and community, is needed for the betterment of human health and the environment. Received: February 26, 2001 / Accepted: October 11, 2002