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.     

Model development for household waste prevention behaviour

Understanding waste prevention behaviour (WPB) could enable local governments and decision makers to design more-effective policies for reducing the amount of waste that is generated. By merging well-known attitude–behaviour theories with elements from wider models from environmental psychology, an extensive cognitive framework that provides new and valuable insights is developed for understanding the involvement of individuals in waste prevention. The results confirm the usefulness of the theory of planned behaviour and of Schwartz’s altruistic behaviour model as bases for modelling participation in waste prevention. A more elaborate integrated model of prevention was shown to be necessary for the complete analysis of attitudinal aspects associated with waste prevention. A postal survey of 158 respondents provided empirical support for eight of 12 hypotheses. The proposed structural equation indicates that personal norms and perceived behaviour control are the main predictors and that, unlike the case of recycling, subjective norms have a weak influence on WPB. It also suggests that, since social norms have not presented a direct influence, WPB is likely to be influenced by a concern for the environment and the community as well by perceptions of moral obligation and inconvenience. Results also proved that recycling and waste prevention represent different dimensions of waste management behaviour requiring particular approaches to increase individuals’ engagement in future policies.     

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.     

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.     

Measurement and management of hospital waste in southern Iran: a case study

One of the requirements for development of human societies is the establishment of new healthcare centers. A variety of wastes are generated in healthcare centers depending on the type of activities. This study was conducted to identify, measure and manage different types of hospital wastes as a case study in a hospital located in southern Iran. For this purpose, a questionnaire was initially designed and distributed among the relevant experts to survey the current trend of waste management in the hospital in terms of waste collection, storage and disposal. Afterwards, the hospital waste was sampled during two seasons of fall and winter. The samples were weighted for seven consecutive days in the middle of each season. Approximately, 10 % of the total waste bags per day collected round the clock were selected for further analysis. The obtained results indicated that infectious-hazardous and pseudo-household wastes were, respectively, about 3.79 kg/day/bed, 1.36 kg/day/bed and 2.43 kg/day/bed of the total generated waste in the hospital. As the research findings suggest, proper separation of infectious and pseudo-household wastes at the source would be an essential step towards mitigating environmental and health risks and minimizing the cost of the hospital waste management.     

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.     

Indicators of waste management efficiency related to different territorial conditions

The amount of waste produced and the control of separate collection are crucial issues for the planning of a territorial Integrated Waste Management System, enabling the allocation of each sorted waste fraction to the proper treatment and recycling processes. The present study focuses on assessing indicators of different waste management systems in areas characterized by different territorial conditions. The investigated case study concerns the municipalities of Emilia Romagna (northern Italy), which present a rather uniform socioeconomic situation, but a variety of geographic, urban and waste management characteristics. A survey of waste generation and collection rates was carried out, and correlated with the different territorial conditions, classifying the municipalities according to altitude and population density. The best environmental performances, in terms of high separate collection rate, were found on average in rural areas in the plain, while the lowest waste generation was associated with rural hill towns.     

Characteristics of healthcare wastes

A comprehensive understanding of the quantities and characteristics of the material that needs to be managed is one of the most basic steps in the development of a plan for solid waste management. In this case, the material under consideration is the solid waste generated in healthcare facilities, also known as healthcare waste. Unfortunately, limited reliable information is available in the open literature on the quantities and characteristics of the various types of wastes that are generated in healthcare facilities. Thus, sound management of these wastes, particularly in developing countries, often is problematic. This article provides information on the quantities and properties of healthcare wastes in various types of facilities located in developing countries, as well as in some industrialized countries. Most of the information has been obtained from the open literature, although some information has been collected by the authors and from reports available to the authors. Only data collected within approximately the last 15 years and using prescribed methodologies are presented. The range of hospital waste generation (both infectious and mixed solid waste fractions) varies from 0.016 to 3.23kg/bed-day. The relatively wide variation is due to the fact that some of the facilities surveyed in Ulaanbaatar include out-patient services and district health clinics; these facilities essentially provide very basic services and thus the quantities of waste generated are relatively small. On the other hand, the reported amount of infectious (clinical, yellow bag) waste varied from 0.01 to 0.65kg/bed-day. The characteristics of the components of healthcare wastes, such as the bulk density and the calorific value, have substantial variability. This literature review and the associated attempt at a comparative analysis point to the need for worldwide consensus on the terms and characteristics that describe wastes from healthcare facilities. Such a consensus would greatly facilitate comparative analyses among different facilities, studies and countries.     

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.     

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.     

A model to minimize joint total costs for industrial waste producers and waste management companies.

The model LINKopt is a mixed-integer, linear programming model for mid- and long-term planning of waste management options on an inter-company level. There has been a large increase in the transportation of waste material in Germany, which has been attributed to the implementation of the European Directive 75/442/EEC on waste. Similar situations are expected to emerge in other European countries. The model LINKopt has been developed to determine a waste management system with minimal decision-relevant costs considering transportation, handling, storage and treatment of waste materials. The model can serve as a tool to evaluate various waste management strategies and to obtain the optimal combination of investment options. In addition to costs, ecological aspects are considered by determining the total mileage associated with the waste management system. The model has been applied to a German case study evaluating different investment options for a co-operation between Daimler-Chrysler AG at Rastatt, its suppliers, and the waste management company SITA P+R GmbH. The results show that the installation of waste management facilities at the premises of the waste producer would lead to significant reductions in costs and transportation.     

One size fits all? An assessment tool for solid waste management at local and national levels

As environmental awareness rises, integrated solid waste management (WM) schemes are increasingly being implemented all over the world. The different WM schemes usually address issues such as landfilling restrictions (mainly due to methane emissions and competing land use), packaging directives and compulsory recycling goals. These schemes are, in general, designed at a national or regional level, whereas local conditions and constraints are sometimes neglected. When national WM top-down policies, in addition to setting goals, also dictate the methods by which they are to be achieved, local authorities lose their freedom to optimize their operational WM schemes according to their specific characteristics. There are a myriad of implementation options at the local level, and by carrying out a bottom-up approach the overall national WM system will be optimal on economic and environmental scales. This paper presents a model for optimizing waste strategies at a local level and evaluates this effect at a national level. This is achieved by using a waste assessment model which enables us to compare both the economic viability of several WM options at the local (single municipal authority) level, and aggregated results for regional or national levels. A test case based on various WM approaches in Israel (several implementations of mixed and separated waste) shows that local characteristics significantly influence WM costs, and therefore the optimal scheme is one under which each local authority is able to implement its best-fitting mechanism, given that national guidelines are kept. The main result is that strict national/regional WM policies may be less efficient, unless some type of local flexibility is implemented. Our model is designed both for top-down and bottom-up assessment, and can be easily adapted for a wide range of WM option comparisons at different levels.     

Healthcare waste management practices and risk perceptions: Findings from hospitals in the Algarve region,Portugal

The management of healthcare wastes is receiving greater attention because of the risks to both human health and the environment caused by inadequate waste management practices. In that context, the objective of this study was to analyse the healthcare waste management practices in hospitals of the Algarve region, Portugal, and in particular to assess the risk perceptions of, and actual risk to, healthcare staff. The study included three of the six hospitals in the region, covering 41% of the bed capacity. Data were collected via surveys, interviews, and on-site observations. The results indicate that waste separation is the main deficiency in healthcare waste practice, with correct separation being positively related to the degree of daily contact with the waste. Risk perceptions of healthcare staff show the highest levels for the environment (4.24) and waste workers (4.08), and the lowest for patients (3.29) and visitors (2.80), again being positively associated with the degree of daily contact. Risk perceptions of healthcare staff are related to the difficulties of the correct separation of wastes and the lack of knowledge concerning the importance of that separation. The risk of infection with needlesticks/sharps is higher during patient care than during waste handling, and the frequency of these injuries is related to the daily tasks of each healthcare group (doctors, nurses, and housekeepers). Furthermore, legislative definitions and classifications of healthcare wastes appear to have conditioned the management practices associated with, and the perceptions of risk concerning, healthcare wastes.     

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.     

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.     

Waste management options in southern Europe using field and experimental data

The applicability of the Waste Management Hierarchy concept that appeared to be an essential element in current national environmental policies was investigated in the case of a region in Southern Europe. The waste generation profile that determines the appropriateness of different waste management options was created after a 1-year municipal waste sampling investigation conducted in the Municipality of Pilea in Northern Greece. The paper describes the results of (1) the sampling method, which was conducted four times during 1 year (once per season) in selected areas of the city, (2) the qualitative analysis of the collected samples and (3) the waste treatment, which consisted of drying, grinding, calorific value measurement, incineration and chemical analysis of the collected samples. Comparative analysis between the above mentioned data and on past data derived from investigations conducted in other Greek regions with similar characteristics to those of Pilea were used to identify and discuss future trends in the composition of generated waste over time. An analysis of the current waste management status in Greece as well as the feasibility of implementing a comprehensive management approach is assessed taking into account guidelines set worldwide to promote renewable energy sources use. It is concluded that recycling, perhaps the most positively received of all waste management practices, is going to be an essential part of contemporary waste management strategies, composting can play an important role, while incineration seems to be a conditionally feasible solution.     

Alternative approaches for better municipal solid waste management in Mumbai, India

Waste is an unavoidable by product of human activities. Economic development, urbanization and improving living standards in cities, have led to an increase in the quantity and complexity of generated waste. Rapid growth of population and industrialization degrades the urban environment and places serious stress on natural resources, which undermines equitable and sustainable development. Inefficient management and disposal of solid waste is an obvious cause of degradation of the environment in most cities of the developing world. Municipal corporations of the developing countries are not able to handle increasing quantities of waste, which results in uncollected waste on roads and in other public places. There is a need to work towards a sustainable waste management system, which requires environmental, institutional, financial, economic and social sustainability. This study explores alternative approaches to municipal solid waste (MSW) management and estimates the cost of waste management in Mumbai, India. Two alternatives considered in the paper are community participation and public private partnership in waste management. Data for the present study are from various non-governmental organizations (NGOs) and from the private sector involved in waste management in Mumbai. Mathematical models are used to estimate the cost per ton of waste management for both of the alternatives, which are compared with the cost of waste management by Municipal Corporation of Greater Mumbai (MCGM). It is found that the cost per ton of waste management is Rs. 1518 (35 US dollars) with community participation; Rs. 1797 (41 US dollars) with public private partnership (PPP); and Rs. 1908 (44 US dollars) when only MCGM handles the waste. Hence, community participation in waste management is the least cost option and there is a strong case for comprehensively involving community participation in waste management.     

RECOMMENDATIONS FOR THE MANAGEMENT OF WASTES FROM HEALTHCARE FACILITIES IN HELSINKI

In Helsinki, Finland, new guidelines have been adopted for the management of wastes from healthcare facilities. The purpose has been to rationalize waste management, reducing the amount of waste needing special treatment and lowering costs, while at the same time maintaining occupational safety and preventing environmental hazards. The changes are mainly due to the new definition of infectious waste, based on practical assessment of the possibility of spread of infection via the wastes. As a result, it has been possible to omit one chain of waste handling which has led to simpler practices and economic benefits. Sanitary landfill has been accepted for disposal of clinical waste, except for the biological waste to be incinerated for ethical reasons and infectious waste contaminated by class 4 viruses,Yersinia pestisorBacillus anthracis. Diseases caused by these micro-organisms are not a practical problem in Finland.     

The effect of dynamic scheduling and routing in a solid waste management system

Solid waste collection and hauling account for the greater part of the total cost in modern solid waste management systems. In a recent initiative, 3300 Swedish recycling containers have been fitted with level sensors and wireless communication equipment, thereby giving waste collection operators access to real-time information on the status of each container. In this study, analytical modeling and discrete-event simulation have been used to evaluate different scheduling and routing policies utilizing the real-time data. In addition to the general models developed, an empirical simulation study has been performed on the downtown recycling station system in Malmoe, Sweden. From the study, it can be concluded that dynamic scheduling and routing policies exist that have lower operating costs, shorter collection and hauling distances, and reduced labor hours compared to the static policy with fixed routes and pre-determined pick-up frequencies employed by many waste collection operators today. The results of the analytical model and the simulation models are coherent, and consistent with experiences of the waste collection operators.     

International comparative study of 3R and waste management policy developments

Reduce, reuse, and recycle (3R) policies form the basis of waste management and global warming countermeasures globally, so we conducted a comparative study of 3R and waste management policies in the European Union (EU), USA, Korea, Japan, China, and Vietnam. An international workshop for 3R and waste management policymakers was held in Kyoto, Japan, and a bibliographic survey was also conducted to collect data. 3R policies are clearly given priority in the hierarchy of waste management in every country studied. Thermal recovery, which includes power generation from waste heat and methane gas collected from organic waste, is also a priority; this is consistent with the increased use of countermeasures to reduce greenhouse gas (GHG) emissions. In the EU, waste management is characterized by practical and effective 3R policies through the development of realistic regulations and by the policymakers??desire to simplify management systems. The policy ideal in China, however, is the development of a circular economy that targets reductions in the amount and hazardousness of waste. Limits on the number of final disposal sites, strategies for procuring resources, and GHG emission countermeasures are closely linked with 3R policies, and further development of 3R policies in parallel with such issues is expected.