Hospital waste management in Libya: A case study

In Libya, as in many developing countries, little information is available regarding generation, handling and disposal of hospital waste. This fact hinders the development and implementation of hospital waste management schemes. The specific objective of this study is to present an appraisal of the current situation regarding hospital waste management in Libya. Procedures, techniques, methods of handling, and disposal of waste are presented, as well as the amounts and compositions of hospital waste. This research was conducted in the form of a case study. Fourteen different healthcare facilities in three cities, Tripoli, Misurata, and Sirt, all located in the northwestern part of Libya, were selected for investigation. The investigation showed that the hospitals surveyed had neither guidelines for separated collection and classification, nor methods for storage and disposal of generated waste. This deficiency indicates the need for an adequate hospital waste management strategy to improve and control the existing situation. The average waste generation rate was found to be 1.3 kg/patient/day, comprised of 72% general healthcare waste (non-risk) and 28% hazardous waste. The average general waste composition was: 38% organic, 24% plastics, and 20% paper. Sharps and pathological elements comprised 26% of the hazardous waste component.     

EU landfill waste acceptance criteria and EU Hazardous Waste Directive compliance testing of incinerated sewage sludge ash

A hazardous waste assessment has been completed on ash samples obtained from seven sewage sludge incinerators operating in the UK, using the methods recommended in the EU Hazardous Waste Directive. Using these methods, the assumed speciation of zinc (Zn) ultimately determines if the samples are hazardous due to ecotoxicity hazard. Leaching test results showed that two of the seven sewage sludge ash samples would require disposal in a hazardous waste landfill because they exceed EU landfill waste acceptance criteria for stabilised non-reactive hazardous waste cells for soluble selenium (Se). Because Zn cannot be proven to exist predominantly as a phosphate or oxide in the ashes, it is recommended they be considered as non-hazardous waste. However leaching test results demonstrate that these ashes cannot be considered as inert waste, and this has significant implications for the management, disposal and re-use of sewage sludge ash.     

Medical wastes management in the south of Brazil

In developing countries, solid wastes have not received sufficient attention. In many countries, hazardous and medical wastes are still handled and disposed together with domestic wastes, thus creating a great health risk to municipal workers, the public and the environment. Medical waste management has been evaluated at the Vacacai river basin in the State of Rio Grande do Sul, Brazil. A total of 91 healthcare facilities, including hospitals (21), health centers (48) and clinical laboratories (22) were surveyed to provide information about the management, segregation, generation, storage and disposal of medical wastes. The results about management aspects indicate that practices in most healthcare facilities do not comply with the principles stated in Brazilian legislation. All facilities demonstrated a priority on segregation of infectious-biological wastes. Average generation rates of total and infectious-biological wastes in the hospitals were estimated to be 3.245 and 0.570 kg/bed-day, respectively.     

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     

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.     

Guidelines for the evaluation and assessment of the sustainable use of resources and of wastes management at healthcare facilities.

This paper presents guidelines that can be used by managers of healthcare facilities to evaluate and assess the quality of resources and waste management at their facilities and enabling the principles of sustainable development to be addressed. The guidelines include the following key aspects which need to be considered when completing an assessment. They are: (a) general management; (b) social issues; (c) health and safety; (d) energy and water use; (e) purchasing and supply; (f) waste management (responsibility, segregation, storage and packaging); (g) waste transport; (h) recycling and re-use; (i) waste treatment; and (j) final disposal. They identify actions required to achieve a higher level of performance which can readily be applied to any healthcare facility, irrespective of the local level of social, economic and environmental development. The guidelines are presented, and the characteristics of facilities associated with sustainable (level 4) and unsustainable (level 0) healthcare resource and wastes management are outlined. They have been used to assess a major London hospital, and this highlighted a number of deficiencies in current practice, including a lack of control over purchasing and supply, and very low rates of segregation of municipal solid waste from hazardous healthcare waste.     

Current status and future focus of hazardous waste management in China

 Rapid social and economic development in China has caused the amount of hazardous wastes being generated to increase drastically. The necessary regulations and systems regarding the management of hazardous wastes are currently still not in place. Based on an analysis of the characteristics of hazardous waste pollution and pollution trends in China, this paper reports on China's current status regarding hazardous waste management, and introduces the main difficulties to be faced. The principles and objectives, and the action plan for hazardous waste pollution control in China are also explained in detail. These principles and objectives have been stipulated in the Technological Policies on Hazardous Waste Pollution Control, which is issued by China State EPA, State ETC, and the Science and Technology Ministry. Received: April 30, 2002 / Accepted: October 17, 2002     

An analysis of a European hazardous waste transport registration system (EARS)

In this study a system analysis is presented for a European registration system for hazardous waste shipment notifications. The administrative procedures for the notifications according to the European Community (EC) directives are in use in several Member States, among others the Netherlands and Belgium. The new system should enable efficient notification procedures, without the large number of forms and the delays in obtaining transit and import permissions that are currently observed. Only one form is needed for each hazardous waste transport within the EC, accompanying the transport.The system also allows the generation of compiled information for all EC Member States by using a database structure. Rather than manually administrating the information of the forms, this information is transmitted and stored electronically. With an estimated number of 100,000 transfrontier transports of hazardous waste per year in the European Community, this greatly decreases time and costs for aggregating hazardous waste transport data. This aggregated information is necessary for the implementation, evaluation and further development of a coherent EC waste management policy for hazardous waste treatment and disposal.     

The current situation of solid waste generation and its environmental contamination in China

In China, controlling environmental pollution resulting from solid waste (SW) and hazardous waste (HW) has become one of the most pressing tasks in the field of environmental engineering. It is reported that the annual generation of industrial solid waste (ISW) in China exceeded 0.6 billion tons in the 1990s, and is increasing every year. Although ISW management has been strengthened in recent years, about 40% of SW is put in uncontrolled landfill without appropriate treatment. According to statistics from the national Environmental Protection Agency, the cumulative ISW uncontrolled landfill in China had reached 6.6 billion tons by the end of 1995, occupying around 55 000 hectares of land. Although some major uncontrolled landfills were constructed, nonetheless groundwater contamination resulted from the use of low-standard liners and poor management. Furthermore, about 20 million tons of ISW was discharged into the environment illegally, and a third of this waste was discharged directly into water bodies, making ISW one of the greatest pollution sources for surface water and ground water. Environmental pollution accidents resulting from SW occur about 100 times a year in China, and environmental issues frequently arise because of ISW pollution. The practices of SW management, treatment, and disposal started relatively late in China, and for a long time the management of SW pollution has received little attention compared with water and air pollution management. China faces problems such as the insufficiency of management laws and regulations, insufficient investment, inadequate treatment and disposal technology, and a lack of qualified technicians. At present, most treatment and disposal technology cannot meet the requests for solid waste pollution control. In order to protect, restore, and improve environmental quality in China and to realize sustainable development, the safe management and disposal of solid and hazardous wastes is a pressing challenge. In recent years, much attention has been paid to SW management in China, and investment to develop management and treatment technologies has increased. In 1995, the Law for Solid Waste Pollution Protection was issued, and work on solid waste treatment and disposal began to be legally managed. SW treatment and disposal facilities have been constructed, and now operate in some large and medium-sized cities. In particular, rapid improvements have been seen in ISW recycling, collection, and disposal of municipal solid waste and regional HW management. All the figures in this paper are from 1995, and represent the situation in China in that year. Received: April 18, 2000 / Accepted: May 15, 2000     

2020年危险废物市场分析

危险废物处理与政策、法规、标准、技术、市场等影响因素关系密切。对2019年以来我国出台的危险废物管理政策法规、管理措施和标准规范情况进行梳理,对危险废物产生和利用处置情况进行对比分析,对危险废物利用处置技术进展、价格变动和市场投资趋势等进行概述,对环境违法案件舆情及突发事件等因素对危险废物市场影响进行分析,综合运用类比、归纳和演绎等方法,对2020年危险废物市场进行预测分析。     

Hazardous industrial waste management in Vietnam: current status and future direction

This article concentrates on the existing situation of hazardous industrial waste management in Vietnam. To realize the importance of the development of a Vietnam national strategy based on the reduce, reuse, recycle (3R) concept to the year 2020, the author summarizes the practice of recycling activities of hazardous industrial waste and discusses the challenges arising from increases in the quantity and types of waste and the level of hazard of the waste generated considering that the technical infrastructure for handling and managing the waste is inadequate and the legal system on environmental protection is lacking. In order to improve the existing situation of hazardous industrial waste management, the Vietnamese Government recently has played an increasing role in promoting regional and international cooperation on environmental protection through ratifying the international conventions on the environment including the Basel Convention on the Control of Trans-boundary Movements of Hazardous Waste and their Disposal and the International Labor Organization Convention on Safety in the Use of Chemicals at Work and by adhering to the concept of the material-cycle society. These steps are key opportunities for applying the principles of 3R to the recovery of value from hazardous waste in the future.     

Management of hazardous medical waste in Croatia

This article provides a review of hazardous medical waste production and its management in Croatia. Even though Croatian regulations define all steps in the waste management chain, implementation of those steps is one of the country's greatest issues. Improper practice is evident from the point of waste production to final disposal. The biggest producers of hazardous medical waste are hospitals that do not implement existing legislation, due to the lack of education and funds. Information on quantities, type and flow of medical waste are inadequate, as is sanitary control. We propose an integrated approach to medical waste management based on a hierarchical structure from the point of generation to its disposal. Priority is given to the reduction of the amounts and potential for harm. Where this is not possible, management includes reduction by sorting and separating, pretreatment on site, safe transportation, final treatment and sanitary disposal. Preferred methods should be the least harmful for human health and the environment. Integrated medical waste management could greatly reduce quantities and consequently financial strains. Landfilling is the predominant route of disposal in Croatia, although the authors believe that incineration is the most appropriate method. In a country such as Croatia, a number of small incinerators would be the most economical solution.     

A total quality management approach to healthcare waste management in Namazi Hospital,Iran

BackgroundHealthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75–90% of these wastes are classified as household waste posing no potential risk, 10–25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran.Materials and methodsNamazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period.ResultsBefore the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste.ConclusionA structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings.     

Veterinary waste disposal: practice and policy in Durban, South Africa (2001-2003)

In South Africa, until recently, veterinary waste has not been included in definitions of health care waste, and so has been neglected as a contributor to the hazardous waste stream. Despite the application of, for example, the "Polluter Pays" principle in South African environmental legislation, to generators of waste, which would include veterinarians, there appears to be little awareness of and even less enforcement of the legislation in this regard. This paper reports on a 2001-2003 survey of management practices of the five waste contractors servicing just over half of the veterinarians in Durban, South Africa's second largest city. Some of their activities, when evaluated in terms of the legislation, guidelines and policies relating to waste handling and disposal, were found to be non-compliant. Since any discussion on waste management should take cognisance of waste from generation to final disposal, the responsibility of veterinarians as waste generators is also discussed in the light of the recent developments in health care waste management in South Africa. This study presents a review of past and current policies, legislation and guidelines that have application to veterinary waste. This is the first study to address veterinary waste disposal in any South African city.     

Clinical solid waste management practices and its impact on human health and environment--A review

The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.     

Status and challenges of hospital solid waste management: case studies from Thailand, Pakistan, and Mongolia

Healthcare waste management is a serious public health concern. In developing countries, compared to developed nations, the management of infectious wastes has not received sufficient attention. Recently, worldwide awareness has grown of the need to impose stricter controls on the handling and disposal of wastes generated by healthcare facilities. This exploratory study attempted in seven selected hospitals to explain the situation of healthcare waste management, with a focus on handling practices, occupational safety, and the implementation status of waste management policy, together with other pertinent policy issues. It was noted that the current system of healthcare waste management was underdeveloped and was in dire need of immediate attention and improvement, especially in Mongolia and Pakistan; the medical waste management practices were better in the hospitals studied in Thailand. This study underscores the importance for improvement of medical waste management of a national regulatory framework, a sound internal management system, and programs to train and ensure the safety of related personnel, as well as programs to estimate quantities of waste generated and to evaluate appropriate techniques of disposal. Once a healthcare waste management plan has been prepared, a regular program of inspection and review can be undertaken within the healthcare institution. A good inspection program can also expose problems and new issues in managing healthcare wastes.     

Accessing EPA's hazardous waste remediation technology information

Hazardous waste remediation technologies are rapidly evolving, and it is a challenge for environmental consultants and those working in the government and public sectors to remain current with those technologies. Fortunately, the U.S. Environmental Protection Agency (EPA), through a variety of programs and initiatives, has been a leader in providing information on hazardous waste remediation technologies. This article provides an overview of EPA remediation programs and guides the reader through valuable EPA information sources including publications, databases, and on-line services.     

Sustainable management measures for healthcare waste in China

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

Report: The assessment of hospital waste management:a case study in Tehran

Hospital waste management is an important process that must be dealt with diligently. The management of hazardous waste material requires specific knowledge and regulations and it must be carried out by specialists in the field. In this cross-sectional study, we assessed the main stages of hospital waste management including separation, containment, removal and disposal of waste materials in public hospitals affiliated with Tehran University of Medical Sciences (TUMS). We selected 108 units of six hospitals (three general hospitals and three subspecialty hospitals) from those hospitals supervised by TUMS using the cluster sampling method. The measurement was conducted through a questionnaire and direct observation by researchers. Association analysis was done by statistical tests; Fisher exact test and chi-squared using SPSS software. According to the results obtained by the questionnaire, most of the studied wards scored moderately in terms of quality of their performance in all stages of waste management. About one-fifth of the wards were suffering from poor management of their medical waste and only a minority of wards obtained good scores for managing their waste materials. The findings also revealed significant associations between temporary waste storage and collection and the level of education of the managers (P = 0.040, P = 0.050, respectively). In summary, the study indicated a moderate management in all processes of separation, collection, containment, removal and disposal of waste materials in hospitals with several observed problems in the process.     

Nasreya: a treatment and disposal facility for industrial hazardous waste in Alexandria, Egypt: phase I.

A facility for the treatment and disposal of industrial hazardous waste has been established in Alexandria, Egypt. Phase I of the facility encompassing a secure landfill and solar evaporation ponds is ready to receive waste, and Phase II encompassing physico-chemical treatment, solidification, and interim storage is underway. The facility, the Nasreya Centre, is the first of its kind in Egypt, and represents the nucleus for the integration, improvement and further expansion of different hazardous waste management practices and services in Alexandria. It has been developed within the overall legal framework of the Egyptian Law for the Environment, and is expected to improve prospects for enforcement of the regulatory requirements specified in this law. It has been developed with the overall aim of promoting the establishment of an integrated industrial hazardous waste management system in Alexandria, serving as a demonstration to be replicated elsewhere in Egypt. For Phase I, the Centre only accepts inorganic industrial wastes. In this respect, a waste acceptance policy has been developed, which is expected to be reviewed during Phase II, with an expansion of the waste types accepted.