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.     

Monthly variations in solid waste generation

The monthly quantities of residential, commercial, industrial and other wastes generated between 1985–1989 in Brown County, Wisconsin, U.S.A. are analysed. For each month and each waste type, the quantity of waste generated is compared with the monthly average and the difference is computed as a percentage. The means and standard deviations of these percentage differences are computed for each month using the five values computed for each of the five years. The generation patterns for residential, commercial, construction and demolition wastes, and discarded tires show lower than average generation in winter months and higher than average in summer months, with the residential and commercial components being the most predictable. Ash has the opposite pattern with the most produced in winter months. General industrial wastes are produced at an almost constant rate throughout the year, typically varying by less than 10% from the monthly average. Sludge appears to be the least predictable component of the waste stream.     

Management of hazardous waste in Thailand: present situation and future prospects

 This paper deals with the present scenario of hazardous waste management practices in Thailand, and gives some insights into future prospects. Industrialization in Thailand has systematically increased the generation of hazardous waste. The total hazardous waste generated in 2001 was 1.65 million tons. It is estimated that over 300 million kg/year of hazardous waste is generated from nonindustrial, community sources (e.g., batteries, fluorescent lamps, cleansing chemicals, pesticides). No special facilities are available for handling these wastes. There are neither well-established systems for separation, storage, collection, and transportation, nor the effective enforcement of regulations related to hazardous wastes management generated from industrial or nonindustrial sectors. Therefore, because of a lack of treatment and disposal facilities, these wastes find their way into municipal wastewaters, public landfills, nearby dump sites, or waterways, raising serious environmental concern. Furthermore, Thailand does not have an integrated regulatory framework regarding the monitoring and management of hazardous materials and wastes. In addition to the absence of a national definition of hazardous wastes, limited funding has caused significant impediments to the effective management of hazardous waste. Thus, current waste management practices in Thailand present significant potential hazards to humans and the environment. The challenging issues of hazardous waste management in Thailand are not only related to a scarcity of financial resources (required for treatment and disposal facilities), but also to the fact that there has been no development of appropriate technology following the principles of waste minimization and sustainable development. A holistic approach to achieving effective hazardous waste management that integrates the efforts of all sectors, government, private, and community, is needed for the betterment of human health and the environment. Received: February 26, 2001 / Accepted: October 11, 2002     

Assessment of medical wastes management practice: a case study of the northern part of Jordan

This study includes a survey of the procedures available, techniques, and methods of handling and disposing of medical waste at medium (between 100 and 200 beds) to large (over 200 beds) size healthcare facilities located in Irbid city (a major city in the northern part of Jordan). A total of 14 healthcare facilities, including four hospitals and 10 clinical laboratories, serving a total population of about 1.5 million, were surveyed during the course of this research. This study took into consideration both the quantity and quality of the generated wastes to determine generation rates and physical properties. Results of the survey showed that healthcare facilities in Irbid city have less appropriate practices when it comes to the handling, storage, and disposal of wastes generated in comparison to the developed world. There are no defined methods for handling and disposal of these wastes, starting from the personnel responsible for collection through those who transport the wastes to the disposal site. Moreover, there are no specific regulations or guidelines for segregation or classification of these wastes. This means that wastes are mixed, for example, wastes coming from the kitchen with those generated by different departments. Also, more importantly, none of the sites surveyed could provide estimated quantities of waste generated by each department, based upon the known variables within the departments. Average generation rates of total medical wastes in the hospitals were estimated to be 6.10 kg/patient/day (3.49 kg/bed/day), 5.62 kg/patient/day (3.14 kg/bed/day), and 4.02 kg/patient/day (1.88 kg/bed/day) for public, maternity, and private hospitals, respectively. For medical laboratories, rates were found to be in the range of 0.053-0.065 kg/test-day for governmental laboratories, and 0.034-0.102 kg/test-day for private laboratories. Although, based on the type of waste, domestic or general waste makes up a large proportion of the waste volume, so that if such waste is not mixed with patient derived waste, it can be easily handled. However, based on infections, it is important for healthcare staff to take precautions in handling sharps and pathological wastes, which comprises only about 26% of the total infectious wastes. Statistical analysis was conducted to develop mathematical models to aid in the prediction of waste quantities generated by the hospitals studied, or similar sites in the city that are not included in this study. In these models, the number of patients, number of beds, and hospital type were determined to be significant factors on waste generation. Such models provide decision makers with tools to better manage their medical waste, given the dynamic conditions of their healthcare facilities.     

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.     

Determination of the best appropriate management methods for the health-care wastes in Istanbul

Health-care waste management has been a significant problem in most economically developing countries as it is in Turkey. Most of the time, the main reason for the mismanagement of these wastes is the lack of appropriate legislation and effective control; other reasons are: financial strains and a lack of awareness. Being aware of the significance of the subject, in this paper the management of the health-care wastes in Istanbul, as a Metropolitan City of Turkey, was analyzed to create an integrated health-care waste management system in the city. Within the scope of the study, the existing situation and management practices such as the amount of the health-care wastes generated, segregation procedures, collection, temporary storage and transportation of the wastes within and outside of the institution were examined. Deficiencies, inconsistencies and improper applications were revealed. The existing Turkish Medical Wastes Control Regulation and institutional structure of the health-care waste management body were reviewed. After the evaluation and comparison with the requirements of other national and international organizations, items to be changed/added in the Regulation were identified. At the end of the study, the best management methods for the Istanbul City were determined and started to be applied at the institutions. After this study, the existing Regulation has been changed. The modified Regulation was published in 2005 and implementation has started. It is expected that by the application and implementation of the research outcomes, the management of health-care wastes in Istanbul and then in all over Turkey will be improved. The results obtained can also be used in most economically developing countries where there are similar environmental problems and strict budgets.     

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.     

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.     

Healthcare waste management in the capital city of Mongolia

Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P<0.01). The waste generation rate in the healthcare facilities of Ulaanbaatar was lower than in some other countries; however, the percentage of medical wastes in the total waste stream was comparatively high, ranging from 12.5% to 69.3%, which indicated poor waste handling practices. Despite the efforts for the management of wastes, the current system of healthcare waste management in Ulaanbaatar city of Mongolia is under development and is in dire need of immediate attention and improvement. It is essential to develop a national policy and implement a comprehensive action plan for HCWM providing environmentally sound technological measures to improve HCWM in Mongolia.     

Hospital solid waste management practices in Limpopo Province, South Africa: a case study of two hospitals

The shortcomings in the management practices of hospital solid waste in Limpopo Province of South Africa were studied by looking at two hospitals as case studies. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are used, their daily operations were not carried according to minimum standards. Incinerator ash is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used are also not environmentally friendly as they use old technology. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage composition of the waste was found in the following decreasing order: general waste (60.74%)>medical waste (30.32%)>sharps (8.94%). The mean generation rates were found to be 0.60kg per patient per day.     

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.     

Modeling of urban solid waste management system: the case of Dhaka city

This paper presents a system dynamics computer model to predict solid waste generation, collection capacity and electricity generation from solid waste and to assess the needs for waste management of the urban city of Dhaka, Bangladesh. Simulated results show that solid waste generation, collection capacity and electricity generation potential from solid waste increase with time. Population, uncleared waste, untreated waste, composite index and public concern are projected to increase with time for Dhaka city. Simulated results also show that increasing the budget for collection capacity alone does not improve environmental quality; rather an increased budget is required for both collection and treatment of solid wastes of Dhaka city. Finally, this model can be used as a computer laboratory for urban solid waste management (USWM) policy analysis.     

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.     

Recycling of plastic packaging waste in Bandung City,Indonesia

Economic growth, changing consumption and production patterns are resulting in rapid increase in the generation of plastic wastes, including plastic packaging waste (PPW). A variety of PPW is identified in the municipal solid waste (MSW) stream. In this paper, quantity and composition of PPW at generators (residential and nonresidential sectors) and at the informal sector of waste recycling were measured, and accordingly the flow of PPW within Bandung City, Indonesia was analyzed. Though the generation rate per capita is not so high (25.1 g per day), total PPW generated by 2.3 million inhabitants in Bandung becomes 58.4 tonnes per day (3.76 % of total MSW generated). Due to lack of integrated MSW management, most of PPW is neither collected properly nor disposed of in appropriate manner by the municipality. Collection of valuable wastes including PPW is done predominantly by the informal sector without regard to health and safety. It is predicted that total PPW recycled by various informal waste recycling players like scavengers, junkmen, intermediates, and dealers is 27.5 tonnes per day (64.6 % of total PPW generated). Interviews regarding the existing handling methods and incentives preferred by generators to increase the recycling rate are also presented.     

The role played by environmental factors in the integration of a transfer station in a municipal solid waste management system

Transfer stations are an integral part of present-day municipal solid waste management systems. The main criteria used to decide on the location of a transfer station has traditionally been the minimization of transport costs, since it is cheaper to transport great amounts of waste over long distances in large loads than in small ones. In this study, we are going to consider the environmental factor in order to compare the feasibility of using a transfer station integrated within a waste management system. Applying the Life Cycle Assessment technique will enable us to obtain an objective parameter that quantifies the environmental impact of transportation and of operating a transfer station. Taking the current rates of solid wastes generation in the Plana region of Castellón (Spain) as our starting point, in this study we compare the environmental costs involved in the process of taking municipal wastes directly to the nearest waste treatment facility, with those involved in a waste management system integrating a transfer station. Comparing these two cases, an average reduction of 16.8% in the environmental impact can be obtained when a transfer station is incorporated in the waste management system.     

Concrete with carpet recyclates: suitability assessment by surface energy evaluation

Worn out textile floor coverings are burdensome wastes that are degraded in landfill sites after a very long period of time. One of the ways to manage this kind of waste may be the use of carpet recyclate (CR) as an additive for concrete reinforcement. Therefore, an attempt was made to predict the effects of recyclate additives on the durability a concrete-carpet mixture by employing the method of assessing surface properties of components in the concrete-carpet recyclates composite. Testing was performed on carpet wastes, containing polyamide (PA) and polypropylene (PP) piles and butadiene-styrene resin with chalk filler (BSC) as back coating, to assess the suitability of CR additive for concrete reinforcement by surface energy evaluation. Based on the measurements of contact angles, the free surface energy of recyclate components was determined. The reversible work of adhesion at the interface between these components in dry and wet states was also calculated. The results show that CR with both PA and PP fibers form a strong and water-resistant bond with concrete.     

Management of immunization solid wastes in Kano State, Nigeria

Inadequate management of waste generated from injection activities can have a negative impact on the community and environment. In this paper, a report on immunization wastes management in Kano State (Nigeria) is presented. Eight local governments were selected randomly and surveyed by the author. Solid wastes generated during the Expanded Programme on Immunization were characterised using two different methods: one by weighing the waste and the other by estimating the volume. Empirical data was obtained on immunization waste generation, segregation, storage, collection, transportation, and disposal; and waste management practices were assessed. The study revealed that immunization offices were accommodated in either in local government buildings, primary health centres or community health care centres. All of the stations demonstrated a high priority for segregation of the infectious wastes. It can be deduced from the data obtained that infectious waste ranged from 67.6% to 76.7% with an average of 70.1% by weight, and 36.0% to 46.1% with an average of 40.1% by volume. Non-infectious waste generated ranged from 23.3% to 32.5% with an average of 29.9% by weight and 53.9% to 64.0% with an average of 59.9% by volume. Out of non-infectious waste (NIFW) and infectious waste (IFW), 66.3% and 62.4% by weight were combustible and 33.7% and 37.6% were non-combustible respectively. An assessment of the treatment revealed that open pit burning and burial and small scale incineration were the common methods of disposal for immunization waste, and some immunization centres employed the services of the state or local government owned solid waste disposal board for final collection and disposal of their immunization waste at government approved sites.     

Mathematical modeling to predict residential solid waste generation

One of the challenges faced by waste management authorities is determining the amount of waste generated by households in order to establish waste management systems, as well as trying to charge rates compatible with the principle applied worldwide, and design a fair payment system for households according to the amount of residential solid waste (RSW) they generate. The goal of this research work was to establish mathematical models that correlate the generation of RSW per capita to the following variables: education, income per household, and number of residents. This work was based on data from a study on generation, quantification and composition of residential waste in a Mexican city in three stages. In order to define prediction models, five variables were identified and included in the model. For each waste sampling stage a different mathematical model was developed, in order to find the model that showed the best linear relation to predict residential solid waste generation. Later on, models to explore the combination of included variables and select those which showed a higher R(2) were established. The tests applied were normality, multicolinearity and heteroskedasticity. Another model, formulated with four variables, was generated and the Durban-Watson test was applied to it. Finally, a general mathematical model is proposed to predict residential waste generation, which accounts for 51% of the total.     

A mathematical model to predict the composition and generation of hospital wastes in Iran

The aim of this study is to investigate the quality and quantity of hospital wastes in Iran. The generated hospital wastes have been estimated by the number of hospitals and the number of active beds in each province of Iran in 2001. All data and information have been gathered from: (i) Iran Statistics Center, (ii) literature review, and (iii) hospital waste investigations for an average hospital. Physical analyses have been conducted in terms of various materials (plastic, textile, paper, metal, and others) and components (biological, infectious, medical, and regular wastes). Based on the above-mentioned investigation and information, a mathematical model has been developed to calculate the generation of (infectious) hospital wastes for any desired year. Utilizing the model, generated infectious hospital wastes has been estimated as 698,937 tones for 2008 (short-term) and 3,494,387 tones for 2028 (long-term period). If the real infectious wastes are collected separately, then the generated infectious wastes will be reduced by 15.1% of the above-mentioned amount (139,787 tones for 2008, and 698,877 tones for 2028). Results of physical analysis show the components of the hospital waste as: (a) infectious, 67.3%; (b) medical, 8.8%; (c) biological, 1.8%; and (d) common municipal wastes, 22.1%. An appropriate collection method requires training the staff at hospitals along with preparation of the required facilities. Of course, both of these requirements are cost intensive.     

Use of recycled plastic in concrete: a review

Numerous waste materials are generated from manufacturing processes, service industries and municipal solid wastes. The increasing awareness about the environment has tremendously contributed to the concerns related with disposal of the generated wastes. Solid waste management is one of the major environmental concerns in the world. With the scarcity of space for landfilling and due to its ever increasing cost, waste utilization has become an attractive alternative to disposal. Research is being carried out on the utilization of waste products in concrete. Such waste products include discarded tires, plastic, glass, steel, burnt foundry sand, and coal combustion by-products (CCBs). Each of these waste products has provided a specific effect on the properties of fresh and hardened concrete. The use of waste products in concrete not only makes it economical, but also helps in reducing disposal problems. Reuse of bulky wastes is considered the best environmental alternative for solving the problem of disposal. One such waste is plastic, which could be used in various applications. However, efforts have also been made to explore its use in concrete/asphalt concrete. The development of new construction materials using recycled plastics is important to both the construction and the plastic recycling industries. This paper presents a detailed review about waste and recycled plastics, waste management options, and research published on the effect of recycled plastic on the fresh and hardened properties of concrete. The effect of recycled and waste plastic on bulk density, air content, workability, compressive strength, splitting tensile strength, modulus of elasticity, impact resistance, permeability, and abrasion resistance is discussed in this paper.