Report: Hospital waste management--awareness and practices: a study of three states in India.

The study was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. Hospitals/nursing homes and private medical practitioners in urban as well as rural areas and those from the private as well as the government sector were covered. Information on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with respect to segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. Awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to Common Waste facilities is still limited. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities.     

Report: biomedical waste management practices at Balrampur Hospital, Lucknow, India.

Biomedical waste has become a serious health hazard in many countries, including India. Careless and indiscriminate disposal of this waste by healthcare establishments and research institutions can contribute to the spread of serious diseases such as hepatitis and AIDS (HIV) among those who handle it and also among the general public. The present study pertains to the biomedical waste management practices at Balrampur Hospital, a premier healthcare establishment in Lucknow, in North India. The study shows that infectious and non-infectious wastes are dumped together within the hospital premises, resulting in a mixing of the two, which are then disposed of with municipal waste at the dumping sites in the city. All types of wastes are collected in common bins placed outside the patients wards. For disposal of this waste the hospital depends on the generosity of the Lucknow Municipal Corporation, whose employees generally collect it every 2 or 3 days. The hospital does not have any treatment facility for infectious waste. The laboratory waste materials, which are disposed of directly into the municipal sewer without proper disinfection of pathogens, ultimately reach the Gomti River. All disposable plastic items are segregated by the rag pickers from the hospital as well as municipal bins and dumps. The waste is deposited either inside the hospital grounds, or outside in the community bin for further transportation and disposal along with municipal solid waste. The open dumping of the waste makes it freely accessible to rag pickers who become exposed to serious health hazards due to injuries from sharps, needles and other types of material used when giving injections. The results of the study demonstrate the need for strict enforcement of legal provisions and a better environmental management system for the disposal of biomedical waste in the Balrampur Hospital, as well as other healthcare establishments in Lucknow.     

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.     

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.     

Healthcare waste management: current practices in selected healthcare facilities, Botswana

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.     

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.     

Modelling seasonal variation in biomedical waste generation at healthcare facilities

A mathematical model can help waste planners to optimize waste management systems related to environmental protection. It can also help government bodies set guidelines and regulations, and evaluate prevailing strategies for handling and disposal of waste. In this paper, a technique to develop a mathematical model to correlate the generation rate of biomedical waste (contaminated with blood and body fluid) as a function of bed occupancy and type of ailment (in terms of seasonal changes) using data for two consecutive years from three different healthcare facilities is presented. The data exhibit different trends in biomedical waste generation rates and number of beds occupied in two different years. However, the seasonal variation in biomedical waste production rate remained nearly the same during these 2 years. The fixed trend in biomedical waste generation rate in two consecutive years could be due to similar seasonal illnesses pattern and social factors.     

Comparison of LLW Disposal Facilities at Major Department of Energy Sites

Near surface disposal facility design and management are examined and compared using a systems approach that defines facility performance as a function of three components (or subsystems): the disposal facility design (cover systems and bottom liners); the properties of the waste (waste composition, waste form and waste package); and the site‐specific environmental features (climate, geology, and hydrology). We report an evaluation of five DOE near surface disposal facility case studies, selected to provide a “representative” sample that included disposal sites with a range of waste and environmental characteristics across the DOE. The facilities selected were the Savannah River E‐Area Engineered Trenches, Hanford Integrated Disposal Facility, Idaho Radioactive Waste Management Complex, Oak Ridge Environmental Management Waste Management Facility, and Nevada National Security Site Area 5. ©2015 Wiley Periodicals, Inc.     

Waste to energy: a decision-making process for technology selection through characterization of waste,considering energy and emission in the city of Ahmedabad,India

Journal of Material Cycles and Waste Management - Municipal solid waste (MSW) disposal has become major issue for the city of Ahmedabad, India. Development, concentrated population and economic...     

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

Journal of Material Cycles and Waste Management - Healthcare waste management has become a major issue of concern for solid waste managers due the treatment of healthcare waste being generated and...     

Healthcare waste management in Asia

The risks associated with healthcare waste and its management has gained attention across the world in various events, local and international forums and summits. However, the need for proper healthcare waste management has been gaining recognition slowly due to the substantial disease burdens associated with poor practices, including exposure to infectious agents and toxic substances. Despite the magnitude of the problem, practices, capacities and policies in many countries in dealing with healthcare waste disposal, especially developing nations, is inadequate and requires intensification. This paper looks upon aspects to drive improvements to the existing healthcare waste management situation. The paper places recommendation based on a 12 country study reflecting the current status. The paper does not advocate for any complex technology but calls for changes in mindset of all concerned stakeholders and identifies five important aspects for serious consideration. Understanding the role of governments and healthcare facilities, the paper also outlines three key areas for prioritized action for both parties – budget support, developing policies and legislation and technology and knowledge management.     

Situational analysis of plastic waste management in India and Japan: cross-country learnings to increase plastic circularity

Journal of Material Cycles and Waste Management - Plastic waste is a growing environmental concern. This study compared plastic waste management between India and Japan using SWOT analysis and a...     

Mercury waste management in China: implications on the implementation of the Minamata Convention on Mercury

Journal of Material Cycles and Waste Management - Existing management standards in China for mercury waste classification and disposal and those of the Minamata Convention on Mercury (the...     

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.     

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.     

Medical waste management in Trachea region of Turkey: suggested remedial action.

The main objective of this paper was to analyse the present status of medical waste management in the Trachea region of Turkey and subsequently to draw up a policy regarded with generation, collection, on-site handling, storage, processing, recycling, transportation and safe disposal of medical wastes. This paper also presents the results of study about awareness on how to handle expired drugs. Initially all health-care establishments in Tekirda?, Edirne and Kyrklareli provinces in Trachea region were identified and the amounts of hospital wastes generated by each of them were determined. Current medical waste-management practices, including storage, collection, transportation and disposal, in surveyed establishments were identified. Finally, according to results, remedial measurements for medical waste management in these establishments were suggested. Unfortunately, medical wastes are not given proper attention and these wastes are disposed of together with municipal and industrial solid wastes. The current disposal method is both a public health and environmental hazard. When landfill sites are visited, many scavengers can be seen sorting for recyclable materials, a practice which is dangerous for the scavengers. In addition, it was found that some staff in health-care establishments are unaware of the hazard of medical wastes. It is concluded that a new management system, which consists of segregation, material substitution, minimization, sanitary landfilling and alternative medical waste treatment methods should be carried out. For the best appropriate medical waste management system, health-care establishment employers, managers and especially the members of house- keeping divisions should be involved in medical waste management practice.     

Identifying key factors influencing sustainable element in healthcare waste management using the interval-valued fuzzy DEMATEL method

Journal of Material Cycles and Waste Management - With the rapid growth of healthcare waste and improvement of people’s environment awareness, the sustainability of healthcare waste...     

Investigation of health care waste management in Binzhou District,China

In China, national regulations and standards for health care waste management were implemented in 2003. To investigate the current status of health care waste management at different levels of health care facilities (HCF) after the implementation of these regulations, one tertiary hospital, one secondary hospital, and four primary health care centers from Binzhou District were visited and 145 medical staff members and 24 cleaning personnel were interviewed.Generated medical waste totaled 1.22, 0.77, and 1.17 kg/bed/day in tertiary, secondary, and primary HCF, respectively. The amount of medical waste generated in primary health care centers was much higher than that in secondary hospitals, which may be attributed to general waste being mixed with medical waste. This study found that the level of the HCF, responsibility for medical waste management in departments and wards, educational background and training experience can be factors that determine medical staff members’ knowledge of health care waste management policy. Regular training programs and sufficient provision of protective measures are urgently needed to improve occupational safety for cleaning personnel. Financing and administrative monitoring by local authorities is needed to improve handling practices and the implementation of off-site centralized disposal in primary health care centers.