Current legislation governing clinical waste disposal

Sustainability assessment of healthcare waste treatment systems using surrogate weights and PROMETHEE method

This study aims to assess the sustainability of healthcare waste treatment systems using surrogate weights and the Preference Ranking Organization METHod for Enrichment Evaluations (PROMETHEE). For this purpose, ten treatment systems, including land disposal, incineration and non-incineration systems, were evaluated in terms of environmental, financial, social, and technical criteria. Firstly, fifteen reputed experts assigned their preferred rankings for the groups of criteria and the sub-criteria. The conversion of these rankings into numerical weights was performed using the SR function, which is an additive combination of Sum and Reciprocal weight functions. Secondly, the alternatives' performance with regards to each criterion allowed PROMETHEE to generate the outranking flows for each alternative. The complete ranking revealed that the rotary kiln (A4) is the most sustainable system followed by steam disinfection (A8), dry heat disinfection and microwave disinfection. However, the municipal landfill is the least sustainable system, while chemical disinfection is ranked in the penultimate position of sustainability. The partial ranking indicated that A4 and A8 are incomparable and both were ranked as most sustainable. Therefore, the sustainability of a system cannot be assessed properly without the exact specification of the system itself. In addition, it is preferable to act on the criteria that affect negatively the system to improve its performance.

Selection of inactivation medium for fungal spores in clinical wastes by supercritical carbon dioxide

The present study aimed to select the best medium for inactivation of Aspergillus fumigatus, Aspergillus spp. in section Nigri, A. niger, A. terreus var. terreus, A. tubingensis, Penicillium waksmanii, P. simplicissimum, and Aspergillus sp. strain no. 145 spores in clinical wastes by using supercritical carbon dioxide (SC-CO₂). There were three types of solutions used including normal saline, seawater, distilled water, and physiological saline with 1% of methanol; each solution was tested at 5, 10, and 20 mL of the water contents. The experiments were conducted at the optimum operating parameters of supercritical carbon dioxide (30 MPa, 75 °C, 90 min). The results showed that the inactivation rate was more effective in distilled water with the presence of 1% methanol (6 log reductions). Meanwhile, the seawater decreases inactivation rate more than normal saline (4.5 vs. 5.1 log reduction). On the other hand, the experiments performed with different volumes of distilled water (5, 10, and 20 mL) indicated that A. niger spores were completely inactivated with 10 mL of distilled water. The inactivation rate of fungal spores decreased from 6 to 4.5 log as the amount of distilled water increased from 10 to 20 mL. The analysis for the spore morphology of A. fumigatus and Aspergillus spp. in section Nigri using scanning electron microscopy (SEM) has revealed the role of temperature and pressure in the SC-CO₂ in the destruction of the cell walls of the spores. It can be concluded that the distilled water represent the best medium for inactivation of fungal spores in the clinical solid wastes by SC-CO₂.

A review of legal framework applicable for the management of healthcare waste and current management practices in Ethiopia

The management of healthcare waste (HCW) requires special attention due to the risk posed by the presence of hazardous waste. The first step towards this is the issuance of national legislation complemented by policy documents, regulations and technical guidelines. In Ethiopia there is no specific legislation for healthcare waste management (HCWM). However, there are various legislations which may provide a legal framework for the management of HCW. This review assesses the various legislations that are relevant to HCWM. It also looks into the institutional arrangements put in place and waste management practices that prevail in the country. It was found that, although the existing legislations have provisions that may provide a legal framework for the management of HCW in Ethiopia, they are not comprehensive and lack specificity in terms of defining hazardous HCW and its categories; in indicating legal obligations of healthcare facilities (HCFs) in handling, transporting, treating and disposing HCW, and record keeping and reporting. There is overlapping of mandates and lackof co-ordination among various government institutions that are responsible for HCWM. The HCWM practices also do not conform to the principles of waste management in general and HCWM in particular. Thus, to better manage HCW in Ethiopia, a specific and comprehensive legislation and policy document on HCWM with clear designation of responsibilities to various stakeholders should be issued immediately. Moreover, training and awareness raising activities on proper HCWM should be undertaken targeting medical staffs, HCF administrators, waste handlers, policy and decision makers and the general public.

Clinical solid waste management practices and its impact on human health and environment--A review

The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.

Medical waste production and disposal arising from renal replacement therapy

The treatment of end stage renal disease (ESRD) makes extensive use of pre-sterilised disposable items that are contaminated by blood or other body fluids following use. Commonly these items are incinerated. Because they contain substantial amounts of polyvinylchloride (PVC), their incineration releases polychlorinated dibenzo p dioxins (PCDD) and polychlorinated di benzo p furans (PCF), as well as heavy metals. A consequence of the release of these substances has been the introduction of legislation controlling waste disposal. These issues are likely to impact on the management of waste at the healthcare facility level. In parallel, new PVC-free materials for use in renal replacement therapies have been developed whose incineration is less controversial environmentally.

Protecting the patient and the environment--new aspects and challenges in hospital infection control

Environmental pollution has become a major concern for the future of life on our planet; medical care, especially in hospitals, contributes significantly to this pollution. The increasing usage of highly-developed medical devices, drugs and disposable products are a drain on natural resources as well as financial ones. In this situation, it is a major task for hospital epidemiologists to maintain high standards of hygiene while reducing environmental pollution, reducing consumption of limited natural resources, and minimizing costs. The reduction of hospital waste, the control of polluting and toxic emissions, the avoidance of unnecessary disinfection procedures and disposables, the implementation of energy and water saving technologies are practicable measures in hospital ecology. To realize a sustainable development within hospitals, it is necessary that the need to maintain a balance between effective infection control and a good ecological environment is recognized and supported by health-care workers and the hospital management.