Hospital waste management and toxicity evaluation: a case study

Hospital waste management is an imperative environmental and public safety issue, due to the waste's infectious and hazardous character. This paper examines the existing waste strategy of a typical hospital in Greece with a bed capacity of 400-600. The segregation, collection, packaging, storage, transportation and disposal of waste were monitored and the observed problematic areas documented. The concentrations of BOD, COD and heavy metals were measured in the wastewater the hospital generated. The wastewater's toxicity was also investigated. During the study, omissions and negligence were observed at every stage of the waste management system, particularly with regard to the treatment of infectious waste. Inappropriate collection and transportation procedures for infectious waste, which jeopardized the safety of staff and patients, were recorded. However, inappropriate segregation practices were the dominant problem, which led to increased quantities of generated infectious waste and hence higher costs for their disposal. Infectious waste production was estimated using two different methods: one by weighing the incinerated waste (880 kg day(-1)) and the other by estimating the number of waste bags produced each day (650 kg day(-1)). Furthermore, measurements of the EC(50) parameter in wastewater samples revealed an increased toxicity in all samples. In addition, hazardous organic compounds were detected in wastewater samples using a gas chromatograph/mass spectrograph. Proposals recommending the application of a comprehensive hospital waste management system are presented that will ensure that any potential risks hospital wastes pose to public health and to the environment are minimized.     

Health-care waste management in Lao PDR: a case study.

This study investigated the health-care waste (HCW) management at each health-care facility level at two selected sites in the Lao People's Democratic Republic (Lao PDR): Vientiane Municipality; and Bolikhamxay province. It focused on the amount of HCW, its segregation and the factors influencing HCW management, particularly segregation procedures. A high proportion of incorrectly segregated medical waste was found at each level of health-care facility. Re-segregation revealed 39, 62, 57 and 37% at national hospital, provincial hospital, district hospital and health centre level, respectively, was poorly segregated. The mean of generated HCW was 0.62 kg/bed per day (Vientiane Municipality) and 0.38 kg/bed per day (Bolikhamxay) at two study sites. A higher proportion of medical waste (MW) from the inpatient department at the primary health-care level was found. Thus, HCW management at primary health-care facilities needs more attention and should be better understood.     

Regional medical waste management in China: a case study of Shenyang

Medical waste management is of great importance due to its potential environmental and public health risks, especially in developing countries where both financial and technological resources on medical waste management are still lacking. Although many studies have focused on country-scaled medical waste management, few have paid close attention to regional (city-scale) management, particularly in China. This paper fills such a gap by employing a case study approach. Due to its representative nature, Shenyang was selected as the case study. After a review of China’s medical waste management, an empirical study in Shenyang was conducted in order to analyze the current state as well as identify key challenges on regional medical waste management. Based upon the local realities and aiming to better manage medical wastes, an integrated medical waste management framework is developed. Such a platform encourages the establishment of a specific medical waste management authority, a city scaled capacity building program on improving the general public’s awareness, an information platform, application of state-of-the-art technologies, as well as creation of an effective financial system. The combination of such initiatives can significantly improve the overall eco-efficiency of medical waste management at the regional level and should be promoted to other developing cities.     

Stakeholder analysis for industrial waste management systems

Stakeholder approaches have been applied to the management of companies with a view to the improvement of all areas of performance, including economic, health and safety, waste reduction, future policies, etc. However no agreement exists regarding stakeholders, their interests and levels of importance. This paper considers stakeholder analysis with particular reference to environmental and waste management systems. It proposes a template and matrix model for identification of stakeholder roles and influences by rating the stakeholders. A case study demonstrates the use of these and their ability to be transferred to other circumstances and organizations is illustrated by using a large educational institution.     

Construction waste management based on industrial management models: a Swedish case study.

This paper describes a methodology for estimating the true internal costs of construction waste, aimed at promoting environmentally friendly waste management. The study employs cost-benefit analysis, contribution margin analysis, the polluter-pays principle and a mathematical model: the model for Efficient Use of Resources for Optimal Production Economy (EUROPE), which has been introduced previously by the author for assigning industrial costs to waste. The calculations are performed on construction waste created in a case study of a building project. Moreover, waste is regarded as, in a business sense, having the same basic status as any normal industrial product, namely the 'equality principle'. Application of the methodology is suggested to create incentives for environmental and profitability improvement in construction companies and other types of industrial sectors. The results of the case study show the generation of construction waste to substantially decrease the final operating income, due to the internal shadow price cost it creates. This paper is intended to reduce the gap between the choice of waste management procedures and their economic impact, the overall objective being to accomplish an improved industrial environmental situation.     

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.     

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

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

Report: 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.     

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.     

Industrial solid waste management through the application of multi-criteria decision-making analysis: a case study of Shamsabad industrial complexes

Industrial towns, as major bases of small and medium production centers, have played a major role in the industrial development of several countries. These towns have paved a way for the prosperity of economic plans and have been able to meet up with the production perspectives of investors, thereby providing the necessary fundamental services. In this regard, paying attention to proper management of waste production is quite important both in the preservation of the environment from industrial pollution and reduction of probable risks threatening the employees of industrial units located in the towns. Therefore, the present research determined the stream of the industrial waste production in Shamsabad Industrial Town, by designing four appropriate disposal scenarios according to the quality of the produced wastes, and assesses them technically, economically and environmentally using two methods of analysis: analytic hierarchical process and analytic network process. The fourth scenario, which consisted of landfilling, incineration and recycling, was ultimately selected as the best disposal scenario. Indeed, the main objective of current paper is to develop a model which could be implemented in other industrial towns, to proper management of generated wastes.     

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.     

Medical waste management in Turkey: A case study of Istanbul

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

Role of waste management with regard to climate protection: a case study.

According to the Kyoto Protocol and the burden-sharing agreement of the European Union, Austria is required to cut greenhouse gas (GHG) emissions during the years 2008 to 2012 in order to achieve an average reduction of 13%, based on the level of emissions for the year 1990. The present contribution gives an overview of the history of GHG emission regulation in Austria and identifies the progress made towards the realization of the national climate strategy to attain the GHG emission targets. The contribution uses Austria as an example of the way in which proper waste management can help to reduce GHG emissions. The GHG inventories show that everything must be done to minimize the carbon input due to waste deposition at landfill sites. The incineration of waste is particularly helpful in reducing GHG emissions. The waste-to-energy by incineration plants and recovery of energy yield an ecologically proper treatment of waste using state-of-the-art techniques of a very high standard. The potential for GHG reduction of conventional waste treatment technologies has been estimated by the authors. A growing number of waste incinerators and intensified co-incineration of waste in Austrian industry will both help to reduce national GHG emissions substantially. By increasing the number and capacity of plants for thermal treatment of waste the contribution of proper waste management to the national target for reduction of GHG emissions will be in the range of 8 to 14%. The GHG inventories also indicate that a potential CO2 reduction of about 500 000 t year(-1) is achievable by co-incineration of waste in Austrian industry.     

A charge model for household waste management services: a case study of Tehran municipality

In practice, it is difficult to implement Pay-As-You-Throw charge systems based on accurate estimates of waste generation. In many cities, this is made impossible, due to lack of technical and administrative infrastructure and cultural considerations, especially in developing countries. This paper presents an alternative two-component charge model that is the combination of cost-accounting technique of Waste Management Services (WMSs) and econometric functions of waste generation. Practical and computation steps considered by the model are presented as a proposal to reform the current system of waste charge in Tehran municipality. The presented model is simple to implement and resolves some of the disadvantages of the traditional methods of waste charge systems, including insufficient revenue to cover the cost of waste management and unfairness related to social inequality.     

The multiple market-exposure of waste management companies: a case study of two Swedish municipally owned companies

This paper describes how the business model of two leading Swedish municipally owned solid waste management companies exposes them to four different but related markets: a political market in which their legitimacy as an organization is determined; a waste-as-material market that determines their access to waste as a process input; a technical market in which these companies choose what waste processing technique to use; and a commercial market in which they market their products. Each of these markets has a logic of its own. Managing these logics and articulating the interrelationships between these markets is a key strategic challenge for these companies.     

Waste management health risk assessment: A case study of a solid waste landfill in South Italy

An integrated risk assessment study has been performed in an area within 5 km from a landfill that accepts non hazardous waste. The risk assessment was based on measured emissions and maximum chronic population exposure, for both children and adults, to contaminated air, some foods and soil. The toxic effects assessed were limited to the main known carcinogenic compounds emitted from landfills coming both from landfill gas torch combustion (e.g., dioxins, furans and polycyclic aromatic hydrocarbons, PAHs) and from diffusive emissions (vinyl chloride monomer, VCM). Risk assessment has been performed both for carcinogenic and non-carcinogenic effects. Results indicate that cancer and non-cancer effects risk (hazard index, HI) are largely below the values accepted from the main international agencies (e.g., WHO, US EPA) and national legislation (D.Lgs. 152/2006 and D.Lgs. 4/2008).     

Municipal solid waste management in China: a comparative analysis

This paper illustrates an overview of the past and present MSWM strategies in China. A comparison is made with MSWM in China, and other developed and developing countries to identify and analyze the problems of existing MSWM, and evaluate some effective suggestion to overcome the limitations. Rapid urbanization and economic growth are the main factors of increasing MSW generation in China. The generating MSW has 55.86 % food waste with high moisture contain due to unavailable source separation. Chinese MSWM is dominated by 60.16 % landfilling, whereas incineration, untreated discharge, and other treatments are 29.84, 8.21, and 1.79 %, respectively. In 2014, a total of 604 sanitary landfills, 188 incineration plants, and 26 other units were used for MSWM. With the magnitude of timing, the increasing rate of incineration unit and disposal capacity is higher than the landfill. In 2004–2014, the disposal capacity of landfill and incineration is increased from 68.89 to 107.44 and 4.49 to 53.3 million tons, respectively. However, the heating value in the majority of Chinese incineration plants is 3000–6700 kJ/kg and the inappropriate leachate treatment can be found in 47 % landfill sites. A proper taxation system for MSW disposal is not fully implemented in China, which has a negative impact on overall MSW recycling. From the comparative study of MSWM, it is revealed that the source separation MSW collection, high energy recovery from incineration plants, appropriate leachate treatment, effective landfill location and management, increase waste recycling and proper taxation system for MSW disposal are essential to improve MSWM in China.     

Healthcare waste management: a case study from the National Health Service in Cornwall, United Kingdom

This paper looks at steps taken towards the development of a 10-year strategy for the management of healthcare waste from the National Health Service (NHS) in Cornwall, United Kingdom. The major issues and challenges that affect the management of waste by the NHS, including its organisational structure and collection infrastructure, are outlined. The waste flows of the main acute medical site are detailed, using waste audits of domestic and clinical bags, redundant equipment, bulky waste, and special waste. Some of the common barriers to change, such as staff habits and public perceptions, are also identified. Recommendations are made with respect to improvements in the overall organisational infrastructure and increased localised control. The recommendations also centre around the formation of strategic partnerships, within the site, between sites and at the broader level between the NHS and its surrounding community. An important challenge to be overcome is the need to progress from the concept of "waste management", to one of sustainable decision making regarding resource use, including methods of waste minimisation at the source and recycling. Staff training and awareness underpin several of the short and medium/long term solutions suggested to reduce the waste at the source and recover value from that produced. These measures could potentially reduce disposal quantities by as much as 20-30% (wt.) and costs by around 25-35%.     

LCA-IWM: a decision support tool for sustainability assessment of waste management systems

The paper outlines the most significant result of the project 'The use of life cycle assessment tools for the development of integrated waste management strategies for cities and regions with rapid growing economies', which was the development of two decision-support tools: a municipal waste prognostic tool and a waste management system assessment tool. The article focuses on the assessment tool, which supports the adequate decision making in the planning of urban waste management systems by allowing the creation and comparison of different scenarios, considering three basic subsystems: (i) temporary storage; (ii) collection and transport and (iii) treatment, disposal and recycling. The design and analysis options, as well as the assumptions made for each subsystem, are shortly introduced, providing an overview of the applied methodologies and technologies. The sustainability assessment methodology used in the project to support the selection of the most adequate scenario is presented with a brief explanation of the procedures, criteria and indicators applied on the evaluation of each of the three sustainability pillars.