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.     

Assessment and analysis of industrial liquid waste and sludge disposal at unlined landfill sites in arid climate

Municipal solid waste disposal sites in arid countries such as Kuwait receive various types of waste materials like sewage sludge, chemical waste and other debris. Large amounts of leachate are expected to be generated due to the improper disposal of industrial wastewater, sewage sludge and chemical wastes with municipal solid waste at landfill sites even though the rainwater is scarce. Almost 95% of all solid waste generated in Kuwait during the last 10 years was dumped in five unlined landfills. The sites accepting liquid waste consist of old sand quarries that do not follow any specific engineering guidelines. With the current practice, contamination of the ground water table is possible due to the close location of the water table beneath the bottom of the waste disposal sites. This study determined the percentage of industrial liquid waste and sludge of the total waste dumped at the landfill sites, analyzed the chemical characteristics of liquid waste stream and contaminated water at disposal sites, and finally evaluated the possible risk posed by the continuous dumping of such wastes at the unlined landfills. Statistical analysis has been performed on the disposal and characterization of industrial wastewater and sludge at five active landfill sites. The chemical analysis shows that all the industrial wastes and sludge have high concentrations of COD, suspended solids, and heavy metals. Results show that from 1993 to 2000, 5.14+/-1.13 million t of total wastes were disposed per year in all active landfill sites in Kuwait. The share of industrial liquid and sludge waste was 1.85+/-0.19 million t representing 37.22+/-6.85% of total waste disposed in all landfill sites. Such wastes contribute to landfill leachate which pollutes groundwater and may enter the food chain causing adverse health effects. Lined evaporation ponds are suggested as an economical and safe solution for industrial wastewater and sludge disposal in the arid climate of Kuwait.     

Solid industrial wastes and their management in Asegra (Granada, Spain)

ASEGRA is an industrial area in Granada (Spain) with important waste management problems. In order to properly manage and control waste production in industry, one must know the quantity, type, and composition of industrial wastes, as well as the management practices of the companies involved. In our study, questionnaires were used to collect data regarding methods of waste management used in 170 of the 230 businesses in the area of study. The majority of these companies in ASEGRA are small or medium-size, and belong to the service sector, transport, and distribution. This was naturally a conditioning factor in both the type and management of the wastes generated. It was observed that paper and cardboard, plastic, wood, and metals were the most common types of waste, mainly generated from packaging (49% of the total volume), as well as material used in containers and for wrapping products. Serious problems were observed in the management of these wastes. In most cases they were disposed of by dumping, and very rarely did businesses resort to reuse, recycling or valorization. Smaller companies encountered greater difficulties when it came to effective waste management. The most frequent solution for the disposal of wastes in the area was dumping.     

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.     

Transforming an open dump into a sanitary landfill: a development effort in waste management

Upgrading a crude dump site into a sanitary landfill is a very challenging task; Matuail landfill site in Dhaka posed just such a challenge. From the very beginning, the existing disposal site had been used for the crude dumping of solid wastes. All types of solid wastes were haphazardly disposed of all over the site. The existing drainage channels of the dumping ground were not operational due to blockage by indiscriminate waste dumping. A large amount of leachate oozing out from the waste mixed with storm water and made the site esthetically very displeasing and environmentally unsound. This adverse situation sometimes caused disruption of the waste vehicular movement. Step-by-step improvement measures have been taken in the open dump to make it controlled and sanitary by adopting simple and locally available materials, technical guidelines, and construction techniques.     

A system dynamics approach for hospital waste management

Healthcare services provided by hospitals may generate some infectious wastes. Although a large percentage of hospital waste is classified as general waste, which has similar nature as that of municipal solid waste and, therefore, could be disposed in municipal landfills, a small portion of infectious waste has to be managed in the proper manner in order to minimize risk to public health. Many factors involved in the hospital waste management system often link to one another, which require a comprehensive analysis to determine the role of each factor in the system. In this paper, we present a hospital waste management model based on system dynamics to determine the interaction among factors in the system using a software package, Stella. A case study of the City of Jakarta, Indonesia is selected. The hospital waste generation is affected by various factors including the number of beds in the hospitals and the NIMBY (not in my back yard) syndrome. To minimize the risk to public health, we found that waste segregation, as well as infectious waste treatment prior to disposal, has to be conducted properly by the hospital management, especially when scavenging takes place in landfill sites in developing countries.     

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.     

Disposal of solid waste in Istanbul and along the Black Sea coast of Turkey

The increasing amount of solid waste arising from municipalities and other sources and its consequent disposal has been one of the major environmental problems in Turkey. Istanbul is a metropolitan city with a current population of around 14 million, and produces about 9000 ton of solid waste every day. The waste composition for Istanbul has changed markedly from 1981 to 1996 with large decreases in waste density, much of which is related to decreased amounts of ash collected in winter. In recent years, the Istanbul region has implemented a new solid waste management system with transfer stations, sanitary landfills, and methane recovery, which has led to major improvements. In the Black Sea region of Turkey, most of the municipal and industrial solid wastes, mixed with hospital and hazardous wastes, are dumped on the nearest lowlands and river valleys or into the sea. The impact of riverside and seashore dumping of solid wastes adds significantly to problems arising from sewage and industry on the Black Sea coast. Appropriate integrated solid waste management systems are needed here as well; however, they have been more difficult to implement than in Istanbul because of more difficult topography, weaker administrative structures, and the lower incomes of the inhabitants.     

Medical waste production at hospitals and associated factors

This study was conducted to evaluate the quantities of medical waste generated and the factors associated with the generation rate at medical establishments in Taiwan. Data on medical waste generation at 150 health care establishments were collected for analysis in 2003. General medical waste and infectious waste production at these establishments were examined statistically with the potential associated factors. These factors included the types of hospital and clinic, reimbursement payment by National Health Insurance, total number of beds, bed occupancy, number of infectious disease beds and outpatients per day. The average waste generation rates ranged from 2.41 to 3.26kg/bed/day for general medical wastes, and 0.19-0.88kg/bed/day for infectious wastes. The total average quantity of infectious wastes generated was the highest from medical centers, or 3.8 times higher than that from regional hospitals (267.8 vs. 70.3Tons/yr). The multivariate regression analysis was able to explain 92% of infectious wastes and 64% of general medical wastes, with the amount of insurance reimbursement and number of beds as significant prediction factors. This study suggests that large hospitals are the major source of medical waste in Taiwan. The fractions of medical waste treated as infectious at all levels of healthcare establishments are much greater than that recommended by the USCDC guidelines.     

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.     

A GIS based transportation model for solid waste disposal--a case study on Asansol municipality

Uncontrolled growth of the urban population in developing countries in recent years has made solid waste management an important issue. Very often, a substantial amount of total expenditures is spent on the collection of solid waste by city authorities. Optimization of the routing system for collection and transport of solid waste thus constitutes an important component of an effective solid waste management system. This paper describes an attempt to design and develop an appropriate storage, collection and disposal plan for the Asansol Municipality Corporation (AMC) of West Bengal State (India). A GIS optimal routing model is proposed to determine the minimum cost/distance efficient collection paths for transporting the solid wastes to the landfill. The model uses information on population density, waste generation capacity, road network and the types of road, storage bins and collection vehicles, etc. The proposed model can be used as a decision support tool by municipal authorities for efficient management of the daily operations for transporting solid wastes, load balancing within vehicles, managing fuel consumption and generating work schedules for the workers and vehicles. The total cost of the proposed collection systems is estimated to be around 80 million rupees for the fixed cost of storage bins, collection vehicles and a sanitary landfill and around 8.4 million rupees for the annual operating cost of crews, vehicles and landfill maintenance. A substantial amount (25 million rupees/yr) is currently being spent by AMC on waste collection alone without any proper storage/collection system and sanitary landfill. Over a projected period of 15 yr, the overall savings is thus very significant.     

Stakeholder-based SWOT analysis for successful municipal solid waste management in Lucknow, India

The present investigation is a case study of Lucknow, the main metropolis in Northern India, which succumbs to a major problem of municipal solid waste and its management. A qualitative investigation using strengths, weaknesses, opportunities and threats analysis (SWOT) has been successfully implemented through this community participation study. This qualitative investigation emphasizes the limited capabilities of the municipal corporation's resources to provide proper facilitation of the municipal solid waste management (MSWM) services without community participation in Lucknow city. The SWOT analysis was performed to formulate strategic action plans for MSWM in order to mobilize and utilize the community resources on the one hand and municipal corporation's resources on the other. It has allowed the introduction of a participatory approach for better collaboration between the community and municipal corporation in Lucknow (India). With this stakeholder-based SWOT analysis, efforts were made to explore the ways and means of converting the possible "threats" into "opportunities" and changing the "weaknesses" into "strengths" regarding a community-based MSWM programme. By this investigation, concrete strategic action plans were developed for both the community and municipal corporation to improve MSWM in Lucknow.     

Report on waste dump sites around Bangalore

The present work aims at identifying, locating and quantifying the industrial and domestic waste dump sites located in and around Bangalore urban and rural districts of Karnataka state, India. Bangalore has a population of 6 million and has more than 2000 industries working at various industrial estates and other locations around the city. It was reported that about 1500 tons of municipal waste per day is being generated from Bangalore city. Studies reveal that there is no scientific treatment and disposal facility for scientific management of the waste generated. The waste from industries and community areas is disposed in an unscientific manner at several open dump sites across the city. There are more than 60 dump sites consisting of both municipal and industrial waste existing in and around Bangalore city; the locations are totally unhygienic. Based on the experience gained from field visits, physical observation of the waste disposed, quantity and nature of the waste disposed, each site was given with a grading based on polluting potential of the site. For selected sites, ground water samples were collected from nearby surface or bore wells and analysed for possible contamination. From the study, it was found that the site needed immediate attention and comes under severe impact category of 27 numbers and that of medium and low impact are 18 and 6 numbers, respectively. The disposal sites have got tremendous potential of spreading the epidemics/diseases to the people living in their immediate vicinity and at nearby places.     

Household waste disposal in Mekelle city, Northern Ethiopia

In many cities of developing countries, such as Mekelle (Ethiopia), waste management is poor and solid wastes are dumped along roadsides and into open areas, endangering health and attracting vermin. The effects of demographic factors, economic and social status, waste and environmental attributes on household solid waste disposal are investigated using data from household survey. Household level data are then analyzed using multinomial logit estimation to determine the factors that affect household waste disposal decision making. Results show that demographic features such as age, education and household size have an insignificant impact over the choice of alternative waste disposal means, whereas the supply of waste facilities significantly affects waste disposal choice. Inadequate supply of waste containers and longer distance to these containers increase the probability of waste dumping in open areas and roadsides relative to the use of communal containers. Higher household income decreases the probability of using open areas and roadsides as waste destinations relative to communal containers. Measures to make the process of waste disposal less costly and ensuring well functioning institutional waste management would improve proper waste disposal.     

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.     

Sustainable waste management in the Indian mining industry.

One of the important sectors that contribute to the national economy is the mining sector. During the mining of minerals and ores, waste materials in the form of overburden are generated. As these are not useful to the mine owners, they may be inappropriately disposed of into the environment, posing serious threat to the environment in the form of land degradation, water and air pollution. The present paper discusses the existing status of waste generation, its characteristics and the disposal methods being adopted in India. Impacts associated with waste disposal practices together with preventive measures for waste disposal are also discussed. Finally, strategies for improvements in existing waste management and for incorporating the same in the overall development plan for the mines are suggested.     

The treatment of infectious waste arising from home health and medical care services: present situation in Japan

The management of waste materials arising from home health and medical care services (HHMC wastes) in Japan is now receiving greater attention from governmental workers dealing with general household waste materials. In general, HHMC waste materials are collected in a mixed form, transported and disposed of along with municipal solid wastes. As a result, municipal workers are suffering needle stick accidents so that infections associated with HHMC waste materials may occur. The collection and transportation by patients and their families of HHMC waste materials with sharp-edges, such as injection needles, to medical-related facilities can prevent municipal workers from experiencing needle-prick accidents. One of the most important strategies for medical-related facilities is hence the education of patients and their families. Improved rules for handling HHMC waste materials are essential for the safe and effective management.     

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.     

Integration of the informal sector into municipal solid waste management in the Philippines – What does it need?

The integration of the informal sector into municipal solid waste management is a challenge many developing countries face. In Iloilo City, Philippines around 220 tons of municipal solid waste are collected every day and disposed at a 10 ha large dumpsite. In order to improve the local waste management system the Local Government decided to develop a new Waste Management Center with integrated landfill. However, the proposed area is adjacent to the presently used dumpsite where more than 300 waste pickers dwell and depend on waste picking as their source of livelihood. The Local Government recognized the hidden threat imposed by the waste picker’s presence for this development project and proposed various measures to integrate the informal sector into the municipal solid waste management (MSWM) program. As a key intervention a Waste Workers Association, called USWAG Calahunan Livelihood Association Inc. (UCLA) was initiated and registered as a formal business enterprise in May 2009. Up to date, UCLA counts 240 members who commit to follow certain rules and to work within a team that jointly recovers wasted materials. As a cooperative they are empowered to explore new livelihood options such as the recovery of Alternative Fuels for commercial (cement industry) and household use, production of compost and making of handicrafts out of used packages. These activities do not only provide alternative livelihood for them but also lessen the generation of leachate and Greenhouse Gases (GHG) emissions from waste disposal, whereby the life time of the proposed new sanitary landfill can be extended likewise.