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Romano L, Giuliani A, Muselli M, Lupi E, Iacomino E, De Nardi P, Vistoli F. Toward Environmentally sustainable surgery: Waste recycling in general surgery operating room. Preliminary cognitive audit. World J Surg 2024. [PMID: 38809181 DOI: 10.1002/wjs.12237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Accepted: 05/19/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND It is common practice to classify waste from the operating theater as "clinical". The development of sustainable policies could have a significant impact. In the first phase, our study aims to measure general surgery waste and to assess the potential financial and carbon savings of appropriate recycling. Based on this information, we will plan for a second phase in which educational interventions will be put in place to promote waste segregation in surgical environments. METHODS We conducted a preliminary cognitive audit of the most common general surgery procedures to examine the types and quantity of waste produced. We calculated the economic and environmental impacts of disposing of waste treated as clinical or general, and we measured how much of it could actually be recycled. Then, we attempted a projection of the savings we could expect if recycling policies were implemented. RESULTS We found that more than 30% of total waste was actually recyclable. Considering a projection based on annual procedures performed in our hospital, we estimated that for each kind of surgical procedure, we could expect a reduction of the carbon footprint by approximately 6%, and an average 3% reduction in costs every year, only by improving waste segregation in the general surgery operating rooms. CONCLUSION There could be a great potential for reducing environmental and economic footprint of the operating rooms by promoting waste recycling protocols. Surgeons are in a unique position to implement for these protocols. Interventions should be codesigned with theater staff to create a "green culture".
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Affiliation(s)
- Lucia Romano
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Antonio Giuliani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Mario Muselli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ettore Lupi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enzo Iacomino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Paola De Nardi
- Gastrointestinal surgery, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Fabio Vistoli
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Pitard M, Rouvière N, Leguelinel-Blache G, Chasseigne V. Contribution of hospital pharmacists to sustainable healthcare: a systematic review. Eur J Hosp Pharm 2024:ejhpharm-2024-004098. [PMID: 38777391 DOI: 10.1136/ejhpharm-2024-004098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND With a global annual carbon footprint of the healthcare sector of 2 gigatons of CO2e, healthcare systems must contribute to the fight against climate change. Hospital pharmacists could be key players in ecological transition due to their role in managing healthcare products. The aim of this study was to summarise the evidence on interventions implemented in healthcare facilities involving pharmacists to improve the environmental footprint of healthcare. METHODS This systematic review was conducted following PRISMA 2020 guidelines. The Medline, Web of Science and ScienceDirect databases were searched for studies published between 2013 and 2023. To be eligible for inclusion, studies had to include hospital pharmacists and present contributions aimed at reducing the environmental footprint of healthcare in healthcare facilities. Outcomes were the description of the contribution, the methods used and the stages of healthcare product lifecycle analysed. A Mixed Methods Appraisal Tool was used to assess the risk of bias for each study. RESULTS Seventeen studies were included. Pharmacists played a leading role in 15 (88%) and had a supporting role in the others. The healthcare products targeted were medicines (59%), medical devices (12%) or both (29%). The stages of the healthcare product cycle addressed by the contributions were elimination (71%), dispensing (35%), procurement and supply (35%), production (29%), and prescription (24%). Only two studies used life cycle assessment and only one assessed all three pillars of sustainability. Two studies had good methodological quality while the rest had at least one element of uncertainty. CONCLUSION This review confirms the central role of the pharmacist and the importance of a multidisciplinary approach in implementing eco-responsible actions. It could be useful to hospitals and other teams wanting to improve sustainable actions and it emphasises the importance of collaborating with pharmacists when planning sustainable initiatives. Future eco-responsible initiatives must use robust reproducible methods. TRIAL REGISTRATION PROSPERO #CRD42023406835.
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Affiliation(s)
- Maria Pitard
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Ninon Rouvière
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
| | - Géraldine Leguelinel-Blache
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
| | - Virginie Chasseigne
- Department of Pharmacy, Nimes University Hospital, University of Montpellier, Nimes, France
- Institute Desbrest of Epidemiology and Public Health, INSERM, University of Montpellier, Montpellier, France
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3
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Huang A, Cooke SM, Garsden C, Behne C, Borkoles E. Transitioning to sustainable, climate-resilient healthcare: insights from a health service staff survey in Australia. BMC Health Serv Res 2024; 24:475. [PMID: 38627700 PMCID: PMC11022411 DOI: 10.1186/s12913-024-10882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND More than 80 countries, including Australia, have made commitments to deliver climate-resilient and low carbon healthcare. Understanding how healthcare workers view their own and their organization's efforts to achieve sustainable and climate-resilient healthcare practice is vital to inform strategies to accelerate that transition. METHODS We conducted an online staff survey in a large state government hospital-and-health-service organisation in Queensland, Australia, to ascertain attitudes and practices towards environmentally sustainable, climate-resilient healthcare, and views about the organizational support necessary to achieve these goals in their workplace. RESULTS From 301 participants showed staff strongly support implementing sustainable and climate-resilient healthcare but require significantly more organizational support. Participants identified three categories of organizational support as necessary for the transition to environmentally sustainable and climate-resilient health services and systems: (1) practical support to make sustainability easier in the workplace (e.g. waste, energy, water, procurement, food, transport etc.); (2) training and education to equip them for 21st century planetary health challenges; and (3) embedding sustainability as 'business as usual' in healthcare culture and systems. CONCLUSIONS The research provides new insight into health workforce views on how organizations should support them to realize climate and sustainability goals. This research has implications for those planning, managing, implementing, and educating for, the transition to environmentally sustainable and climate-resilient health services and systems in Queensland, Australia, and in similar health systems internationally.
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Affiliation(s)
| | | | - Christine Garsden
- Sunshine Coast Hospital and Health Service, Queensland Health, Sunshine Coast, Australia
| | | | - Erika Borkoles
- Griffith Business School, Griffith University, Brisbane, Australia
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4
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Plezia D, Sabol VK, Nelson C, Simmons VC. Improving Waste Segregation in the Operating Room to Decrease Overhead Cost. Qual Manag Health Care 2024; 33:44-51. [PMID: 37296512 DOI: 10.1097/qmh.0000000000000416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Operating rooms (ORs) disproportionally contribute 20% to 33% of hospital waste nationwide and therefore have a major impact on hospital waste management. Seventy percent of general OR waste is incorrectly eliminated as clinical waste, which compounds unnecessary financial burden and produces negative environmental impact. The primary purpose of this quality improvement (QI) project was to evaluate the effectiveness of waste segregation education for OR anesthesia staff on improving waste segregation compliance in the OR. METHODS A waste segregation QI project was implemented at a 19-OR hospital. Sharps bins in each OR were monitored for weight in pounds and 6 ORs were monitored for percent compliance both pre- and post-institution of a waste segregation education. In addition, a waste segregation knowledge assessment, waste segregation barriers assessment, and a demographic survey were administered to anesthesia staff. Twenty-two certified registered nurse anesthetists (CRNAs), 13 anesthesiologists, and 4 anesthesia technicians responded to the initial surveys and assessments while 30 of these original 39 participants (77%) responded following the educational intervention. A cost analysis was calculated pre- and post-implementation by multiplying total weight of the sharps bins by the price per pound of sharps. RESULTS Twenty-three percent of participants reported having formal waste segregation training. Survey responses revealed that the greatest barrier to waste segregation involved bin location (56.4%), followed by lack of time to segregate (25.6%), lack of knowledge of what content goes in the bin (25.6%), and lack of incentive (25.6%). A waste segregation knowledge assessment showed improvement from pre- ( M = 9.18, SD = 1.66) to post-implementation ( M = 9.90, SD = 1.64). Pre-implementation sharps bin compliance was 50.70% while post-implementation bin compliance improved to 58.44%. A 27.64% decrease in sharps disposal cost occurred following implementation, which is estimated to produce a $2964 cost savings per year. CONCLUSIONS Waste segregation education for anesthesia staff increased their waste management knowledge, improved sharps waste bin compliance, and produced an overall cost savings.
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Affiliation(s)
- Daniel Plezia
- Kettering Medical Center, Dayton, Ohio, Duke University School of Nursing, Durham, North Carolina (Drs Plezia, Sabol, and Simmons); and Duke Raleigh, Raleigh, North Carolina (Dr Nelson)
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Ponce P, Aguirre-Padilla N, Orellana-Jimbo M, Larrea-Silva J, Cabrera-Gonzalez V. Analysis of the influence of the COVID-19 outbreak on household solid waste management: An empirical study using PLS-SEM. Sci Prog 2023; 106:368504231206254. [PMID: 37942705 PMCID: PMC10637176 DOI: 10.1177/00368504231206254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
The global increase in solid waste pollution due to economic growth and population growth has led to severe ecological deterioration. This situation is exacerbated by the ongoing coronavirus disease (COVID-19) pandemic, which has significantly impacted consumer behavior and consumption habits. Proper management of solid waste has thus become critical in mitigating environmental degradation. In this study, we aim to examine the relationship between the outbreak of COVID-19, environmental attitudes (EATT), social norms (SN), environmental knowledge (EK), technological innovation (TI), and solid waste management (SWM) in Ecuadorian households during the pandemic. We collected data from 426 households in Ecuador using an online questionnaire and analyzed it using the Partial Least Squares Structural Equation Model method to test the hypotheses. Likewise, we validated the measurement and structural model. The results are novel about SWM, considering a developing country severely affected during the pandemic. Our findings suggest that COVID-19 has a negative impact on SWM, while EATT, SN, and TI have a positive influence on SWM. However, we found that EK does not significantly affect SWM.
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Affiliation(s)
- Pablo Ponce
- Carrera de Economía and Centro de Investigaciones Sociales y Económicas, Universidad Nacional de Loja, Loja, Ecuador
- Faculty of Economics and Business, University of Vigo, Campus Universitario, s/n, Vigo, Spain
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Kinthala S, Yepuri N, Senapathi SH, Ali N, Madabhushi P. Oxygen wastage in operating room and clinical units after hours: A quality improvement project from a single tertiary care institution. J Clin Anesth 2023; 88:111118. [PMID: 37060731 DOI: 10.1016/j.jclinane.2023.111118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/23/2023] [Accepted: 04/01/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Sudhakar Kinthala
- Department of Anesthesiology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA..
| | - Natesh Yepuri
- Department of Anesthesiology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA
| | | | - Naaila Ali
- Department of Anesthesiology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA
| | - Praneeth Madabhushi
- Department of Anesthesiology, Guthrie Robert Packer Hospital, Sayre, PA 18840, USA
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Çelik S, Peker İ, Gök-Kısa AC, Büyüközkan G. Multi-criteria evaluation of medical waste management process under intuitionistic fuzzy environment: A case study on hospitals in Turkey. SOCIO-ECONOMIC PLANNING SCIENCES 2023; 86:101499. [PMID: 36540295 PMCID: PMC9754754 DOI: 10.1016/j.seps.2022.101499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 08/18/2022] [Accepted: 12/10/2022] [Indexed: 06/17/2023]
Abstract
Waste management has come to the fore in the whole world with the increasing impact of the Covid-19 pandemic along with concerns about human health, environmental threats, and socio-economic factors, etc. Medical waste is one of the waste types that need special management processes including particularly collection, storage, separation, and disposal. Healthcare activities create a great amount of medical waste deriving from the hospitals. This study aims to determine the hospital that carries out medical waste management in the most effective way in Erzurum, Turkey. To handle intense uncertainty in the evaluation process, the case is analyzed by Intuitionistic Fuzzy Multi-Criteria Decision-Making (IFMCDM) methods. The present study contributes to the literature by focusing on a real case problem under IF environment in a Group Decision-Making (GDM) framework. Additionally, based on the literature review and expert judgments, the evaluation criteria relevant to the case are defined in this paper. To this end, a four-phased integrated methodology that involves Intuitionistic Fuzzy Weighted Averaging (IFWA), IF Analytical Hierarchy Process (IFAHP), IF Technique for Order Preference by Similarity to Ideal Solution (IFTOPSIS) and One-Dimensional Sensitivity Analysis, is conducted. Firstly, IFWA is aimed to express the significance levels of decision makers (DMs) based on their knowledge, qualifications and experiences. Secondly, IFAHP is used to calculate the importance weights of the decision criteria and IFTOPSIS is preferred to rank the available hospitals. Then, sensitivity analysis is employed to display robustness. According to the results, the most important criteria are Qualified personnel, Health institution infrastructure, and Control of waste, respectively and the most efficient hospital is determined.
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Affiliation(s)
- Sefa Çelik
- Atatürk University, Department of Business Administration, Erzurum, Turkey
| | - İskender Peker
- Gumushane University, Department of Business Administration, Gümüşhane, Turkey
| | - A Cansu Gök-Kısa
- Hitit University, Department of International Trade and Logistics, Çorum, Turkey
| | - Gülçin Büyüközkan
- Galatasaray University, Department of Industrial Engineering, İstanbul, Turkey
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8
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Zaw MWW, Leong KM, Xin X, Lin S, Ho C, Lie SA. The perceptions and adoption of environmentally sustainable practices among anesthesiologists-a qualitative study. Can J Anaesth 2023; 70:313-326. [PMID: 36765014 PMCID: PMC9916493 DOI: 10.1007/s12630-022-02392-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 02/12/2023] Open
Abstract
PURPOSE Previous surveys of anesthesiologists showed that despite a strong interest in implementing environmentally sustainable anesthetic practices, less than a third do so. Qualitative understanding of the capability, opportunity, and motivational factors that influence "green" behavior will inform the design of effective interventions to promote environmentally sustainable practices in the operating room (OR). METHODS We conducted 23 semistructured interviews with anesthesiologists, with data saturation achieved. Applying the Behavior Change Wheel, interview questions addressed "capability," "opportunity," and "motivation" determinants of behavior. RESULTS Preference for sevoflurane and syringe reuse were most commonly cited as existing environmentally sustainable anesthetic practices. Several participants reported lack of knowledge and feedback as impediments to sustainable anesthetic practices. Reported physical barriers included inadequate recycling facilities and abundance of supplies. Interviewees also discussed the importance of habitual behavior in improving skill sets and reducing cognitive load required to perform environmentally sustainable practices. General awareness of environmental issues and aggregation of marginal gains were reasons for environmentally sustainable measures in the OR. Organizational practice and culture played a significant role in the propagation of sustainable anesthetic practices, with senior staff often carrying a greater influence. While the majority preferred a top-down approach to effect change, others favored the use of incentives. CONCLUSION This study provides insight into the factors that influence the adoption of environmentally sustainable practices in the OR. Measures to promote these practices include education and training, feedback on efforts, engagement of senior anesthetists as role models and for change management, environmental restructuring, and policy designs that balance a top-down vs bottom-up approach to influencing change.
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Affiliation(s)
- Ma W W Zaw
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore.
| | - Kah M Leong
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Xiaohui Xin
- Health Services Research Unit, Singapore General Hospital, Singapore, Singapore
| | - Sarah Lin
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Cheryl Ho
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
| | - Sui A Lie
- Division of Anesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, Singapore
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Sebastian S, Dhar A, Baddeley R, Donnelly L, Haddock R, Arasaradnam R, Coulter A, Disney BR, Griffiths H, Healey C, Hillson R, Steinbach I, Marshall S, Rajendran A, Rochford A, Thomas-Gibson S, Siddhi S, Stableforth W, Wesley E, Brett B, Morris AJ, Douds A, Coleman MG, Veitch AM, Hayee B. Green endoscopy: British Society of Gastroenterology (BSG), Joint Accreditation Group (JAG) and Centre for Sustainable Health (CSH) joint consensus on practical measures for environmental sustainability in endoscopy. Gut 2023; 72:12-26. [PMID: 36229172 PMCID: PMC9763195 DOI: 10.1136/gutjnl-2022-328460] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 09/12/2022] [Indexed: 12/08/2022]
Abstract
GI endoscopy is highly resource-intensive with a significant contribution to greenhouse gas (GHG) emissions and waste generation. Sustainable endoscopy in the context of climate change is now the focus of mainstream discussions between endoscopy providers, units and professional societies. In addition to broader global challenges, there are some specific measures relevant to endoscopy units and their practices, which could significantly reduce environmental impact. Awareness of these issues and guidance on practical interventions to mitigate the carbon footprint of GI endoscopy are lacking. In this consensus, we discuss practical measures to reduce the impact of endoscopy on the environment applicable to endoscopy units and practitioners. Adoption of these measures will facilitate and promote new practices and the evolution of a more sustainable specialty.
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Affiliation(s)
- Shaji Sebastian
- Department of Gastroenterology, Hull University Teaching Hospitals NHS Trust, Hull, East Riding of Yorkshire, UK .,Clinical Sciences Centre, Hull York Medical School, Hull, UK
| | - Anjan Dhar
- Department of Gastroenterology, Darlington Memorial Hospital, Darlington, UK,School of Health & Life Sciences, Teesside University, Middlesbrough, UK
| | - Robin Baddeley
- Institute for Therapeutic Endoscopy, King's College Hospital, London, UK,Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Leigh Donnelly
- Department of Gastroenterology, Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Rosemary Haddock
- Department of Gastroenterology, Ninewells Hospital & Medical School, Dundee, UK
| | - Ramesh Arasaradnam
- Applied Biological and Experimental Sciences, Coventry University, Coventry, UK,Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Archibald Coulter
- Department of Gastroenterology, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Benjamin Robert Disney
- Department of Gastroenterology, University Hospitals Coventry & Warwickshire NHS Trust, Coventry, UK
| | - Helen Griffiths
- Department of Gastroenterology, Brecon War Memorial Hospital, Brecon, UK
| | - Christopher Healey
- Department of Gastroenterology, Airedale NHS Foundation Trust, Keighley, UK
| | | | | | - Sarah Marshall
- Bowel Cancer Screening & Endoscopy, London North West University Healthcare NHS Trust, Harrow, UK,Joint Advisory Group on GI Endoscopy, London, UK
| | - Arun Rajendran
- Department of Gastroenterology, Hillingdon Hospitals NHS Foundation Trust, Uxbridge, UK
| | - Andrew Rochford
- Department of Gastroenterology, Royal Free Hospitals, London, UK
| | - Siwan Thomas-Gibson
- Department of Gastroenterology, St Mark's National Bowel Hospital & Academic Institute, London, UK
| | - Sandeep Siddhi
- Department of Gastroenterology, NHS Grampian, Aberdeen, UK
| | - William Stableforth
- Departments of Gastroenterology & Endoscopy, Royal Cornwall Hospital, Truro, UK
| | - Emma Wesley
- Departments of Gastroenterology & Endoscopy, Taunton and Somerset NHS Foundation Trust, Taunton, UK
| | - Bernard Brett
- Department of Gastroenterology, Norfolk and Norwich Hospitals NHS Trust, Norwich, UK
| | | | - Andrew Douds
- Department of Gastroenterology, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | - Mark Giles Coleman
- Joint Advisory Group on GI Endoscopy, London, UK,Department of Colorectal Surgery, Plymouth University Hospitals Trust, Plymouth, UK
| | - Andrew M Veitch
- Department of Gastroenterology, New Cross Hospital, Wolverhampton, UK
| | - Bu'Hussain Hayee
- King's Health Partners Institute for Therapeutic Endoscopy, King's College Hospital NHS Foundation Trust, London, UK
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Slutzman JE, Bockius H, Gordon IO, Greene HC, Hsu S, Huang Y, Lam MH, Roberts T, Thiel CL. Waste audits in healthcare: A systematic review and description of best practices. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2023; 41:3-17. [PMID: 35652693 PMCID: PMC9925917 DOI: 10.1177/0734242x221101531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
Healthcare generates large amounts of waste, harming both environmental and human health. Waste audits are the standard method for measuring and characterizing waste. This is a systematic review of healthcare waste audits, describing their methods and informing more standardized auditing and reporting. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched MEDLINE, Embase, Inspec, Scopus and Web of Science Core Collection databases for published studies involving direct measurement of waste in medical facilities. We screened 2398 studies, identifying 156 studies for inclusion from 37 countries. Most were conducted to improve local waste sorting policies or practices, with fewer to inform policy development, increase waste diversion or reduce costs. Measurement was quantified mostly by weighing waste, with many also counting items or using interviews or surveys to compile data. Studies spanned single procedures, departments and hospitals, and multiple hospitals or health systems. Waste categories varied, with most including municipal solid waste or biohazardous waste, and others including sharps, recycling and other wastes. There were significant differences in methods and results between high- and low-income countries. The number of healthcare waste audits published has been increasing, with variable quality and general methodologic inconsistency. A greater emphasis on consistent performance and reporting standards would improve the quality, comparability and usefulness of healthcare waste audits.
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Affiliation(s)
- Jonathan E Slutzman
- Center for the Environment and
Health, Massachusetts General Hospital, Boston, MA, USA
- Department of Emergency Medicine,
Massachusetts General Hospital, Harvard Medical School, Boston, MA,
USA
| | - Hannah Bockius
- Department of Biomedical
Engineering, University of Delaware, Newark, DE, USA
| | - Ilyssa O Gordon
- Robert J. Tomsich Pathology &
Laboratory Medicine Institute, Department of Pathology, Cleveland Clinic,
Cleveland, OH, USA
| | - Hannah C Greene
- Department of Biology, New York
University Abu Dhabi, Abu Dhabi, United Arab Emirates
| | - Sarah Hsu
- Warren Alpert Medical School,
Brown University, Providence, RI, USA
| | | | - Michelle H Lam
- Department of Chemical and
Biomolecular Engineering, NYU Tandon School of Engineering, Brooklyn, NY,
USA
| | - Timothy Roberts
- Health Sciences Library, NYU
Langone Health, Grossman School of Medicine, New York University, New York,
NY, USA
| | - Cassandra L Thiel
- Grossman School of Medicine,
Wagner Graduate School of Public Service, Tandon School of Engineering, New
York University, New York, NY, USA
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11
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Mouarbes D, Dubois M, Garde E, Raspaud A, Etterlen A, Sarah D, Fabrice H, Cavaignac E. Impact of implementing of Custom Surgical Tray (CST) in ACLR procedure on Sustainable Development (SD). INTERNATIONAL JOURNAL OF SURGERY OPEN 2022. [DOI: 10.1016/j.ijso.2022.100574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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12
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Baumann AAW, Conway N, Doblinger C, Steinhauser S, Paszko A, Lehmann F, Schneider G, Schulz CM, Schneider F. Mitigation of climate change in health care: A survey for the evaluation of providers' attitudes and knowledge, and their view on their organization's readiness for change. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2022; 173:108-115. [PMID: 35927202 DOI: 10.1016/j.zefq.2022.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 05/04/2022] [Accepted: 05/30/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Climate change is the 21st century's greatest threat to health. Anaesthesia is responsible for high levels of waste production, significant greenhouse gas emissions and extensive energy consumption. Our aim was to design an instrument to assess attitudes and knowledge among anaesthetists as well as their organisation's readiness for change regarding climate action. METHODS In 2020, the Provider Education and Evaluation Project (PEEP) questionnaire was sent to anaesthetists working at a university hospital, which contains 65 items in five areas: demographics, personal attitudes, organisational readiness, opportunities, and specific anaesthesiologic knowledge regarding climate action. Except for two open text questions, all questions were closed questions. RESULTS 104 anaesthetists responded to the survey (response rate 62%). Environmental protection and sustainability were important to all participants (100%). Most felt threatened by the ongoing climate crisis (94.2%). While most participants agreed that their employer had the financial or technological capacities and that sustainability targets were compatible with core business activities (approval >60% for all), they felt unprepared and stated that they had too little time to consider environmental aspects during daily routines (disapproval >60% for all). Furthermore, knowledge on topics such as ongoing efforts to tackle climate change or the climate footprint of drugs and medical products, was rather scarce. CONCLUSION The PEEP questionnaire is an applicable and viable tool to assess anaesthetists' knowledge and attitudes towards climate change and organisational readiness for change. While participants care about the climate crisis, organisational readiness was low, especially when it comes to staff readiness (i.e., skills and knowledge) and cultural readiness (i.e., shared values). These aspects need to be considered in order to successfully implement a carbon neutral health care system.
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Affiliation(s)
- Adrian A W Baumann
- Technical University of Munich, TUM School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Neal Conway
- Technical University of Munich, TUM School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Claudia Doblinger
- Technical University of Munich, TUM Campus Straubing for Biotechnology and Sustainability, Innovation and Technology Management, Straubing, Germany
| | - Stefanie Steinhauser
- Department of Health Economy and Entrepreneurship, Technical University of Applied Sciences Amberg-Weiden, Germany
| | - Agata Paszko
- University Hospital Augsburg, Department of Anaesthesiology, University of Augsburg, Augsburg, Germany
| | - Ferdinand Lehmann
- Department of Anaesthesiology and operative Intensive Care Medicine, University Hospital of Giessen, Justus-Liebig-University Giessen, Giessen, Germany
| | - Gerhard Schneider
- Technical University of Munich, TUM School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany
| | - Christian M Schulz
- Technical University of Munich, TUM School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany; KLUG - Deutsche Allianz Klimawandel und Gesundheit e.V., Berlin, Germany
| | - Frederick Schneider
- Technical University of Munich, TUM School of Medicine, Department of Anaesthesiology and Intensive Care, Munich, Germany.
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Sepetis A, Zaza PN, Rizos F, Bagos PG. Identifying and Predicting Healthcare Waste Management Costs for an Optimal Sustainable Management System: Evidence from the Greek Public Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:9821. [PMID: 36011449 PMCID: PMC9408452 DOI: 10.3390/ijerph19169821] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/03/2022] [Accepted: 08/05/2022] [Indexed: 06/15/2023]
Abstract
The healthcare sector is an ever-growing industry which produces a vast amount of waste each year, and it is crucial for healthcare systems to have an effective and sustainable medical waste management system in order to protect public health. Greek public hospitals in 2018 produced 9500 tons of hazardous healthcare wastes, and it is expected to reach 18,200 tons in 2025 and exceed 18,800 tons in 2030. In this paper, we investigated the factors that affect healthcare wastes. We obtained data from all Greek public hospitals and conducted a regression analysis, with the management cost of waste and the kilos of waste as the dependent variables, and a number of variables reflecting the characteristics of each hospital and its output as the independent variables. We applied and compared several models. Our study shows that healthcare wastes are affected by several individual-hospital characteristics, such as the number of beds, the type of the hospital, the services the hospital provides, the number of annual inpatients, the days of stay, the total number of surgeries, the existence of special units, and the total number of employees. Finally, our study presents two prediction models concerning the management costs and quantities of infectious waste for Greece's public hospitals and proposes specific actions to reduce healthcare wastes and the respective costs, as well as to implement and adopt certain tools, in terms of sustainability.
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Affiliation(s)
- Anastasios Sepetis
- Postgraduate Health and Social Care Management Program, University of West Attica, 12244 Athens, Greece
| | - Paraskevi N. Zaza
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece
| | - Fotios Rizos
- Department of Business Administration, University of West Attica, 12241 Athens, Greece
| | - Pantelis G. Bagos
- Department of Computer Science and Biomedical Informatics, University of Thessaly, 35131 Lamia, Greece
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Shoham MA, Baker NM, Peterson ME, Fox P. The environmental impact of surgery: A systematic review. Surgery 2022; 172:897-905. [PMID: 35788282 DOI: 10.1016/j.surg.2022.04.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/31/2022] [Accepted: 04/05/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Climate change is a significant public health threat. Health care comprises 10% of greenhouse gas emissions in the United States, where surgery is especially resource intensive. We did a systematic review to assess and summarize the published evidence of the environmental impact of surgery. METHODS We searched Medline, Embase, Web of Science, and GreenFILE databases for publications that report any environmental impact measure by all surgical subspecialties, including anesthesia. Inclusion criteria were published in English, original research, and passed peer review. Because data were heterogeneous and the aim was broad, we conducted a qualitative summary of data. Where possible, we compare impact measures. RESULTS In the study, 167 articles were identified by our search strategy and reviewed, of which 55 studies met criteria. Eight were about anesthesia, 27 about operating room waste, and 6 were life cycle assessments. Other topics include carbon footprint and greenhouse gas emissions. Nine papers fell into 2 or more categories. Overall, the operating room is a significant source of emissions and waste. Using anesthetic gases with low global warming potential reduces operating room emissions without compromising patient safety. Operating room waste is often disposed of improperly, often due to convenience or knowledge gaps. There are environmental benefits to replacing disposable materials with reusable equivalents, and to proper recycling. Surgeons can help implement these changes at their institution. CONCLUSION Although there is a clear need to lower the carbon footprint of surgery, the quality of research with which to inform protocol changes is deficient overall. Our attempt to quantify surgery's carbon footprint yielded heterogeneous data and few standardized, actionable recommendations. However, this data serves as a starting point for important future initiatives to decrease the environmental impact of surgery.
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Affiliation(s)
- Maia A Shoham
- Stanford University School of Medicine, Stanford, CA
| | | | | | - Paige Fox
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA.
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15
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Mondal R, Mishra S, Pillai JSK, Sahoo MC. COVID 19 Pandemic and biomedical waste management practices in healthcare system. J Family Med Prim Care 2022; 11:439-446. [PMID: 35360761 PMCID: PMC8963639 DOI: 10.4103/jfmpc.jfmpc_1139_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 10/11/2021] [Accepted: 11/24/2021] [Indexed: 12/18/2022] Open
Abstract
The whole world was shaken with the pandemic of Coronavirus Disease (COVID-19) in end of the year 2019. Due to its novel origin, it was required to follow all precautions possible. Dealing with the massive amount of infectious healthcare waste became an enormous challenge. This review identifies the impacts of the pandemic on biomedical waste management. This systematic review was made by using keywords “biomedical waste” and “COVID 19” in open access databases like PubMed, Science Direct, Scopus, Google Scholers etc. 2124 articles downloaded and 765 found duplicate and 634 not related to the topic. after scrutiny with inclusion criteria 102 articles were considered to analyze the practices related to biomedical waste management during pandemic using PRISMA guideline.. The COVID-19 waste segregation, collection, storage, transportation, and disposal are a big challenge with all stakeholders. In order to control the virus spread, strict monitoring of the complete waste management cycle is required. Adoption of appropriate guidelines is paramount to worker safety and containment of infection. Sustainable recycling methods are needed to deal with the ever-increasing plastic waste resulting from mandatory personal protective equipment (PPE) usage. The situation also demands a rethinking of the healthcare system. Overall, there was an increase in BMW generation, and municipal waste had increased globally. Pandemic preparedness requires a global public health strategy and long-term investments. This will be vital for making a robust community capable enough to fight against any public health pressures in the future, as well as the pandemic tremors. Systematized efforts from all stakeholders, at all levels, not only refines epidemic preparation but also helps to attain a sustainable development of health for a healthier future.
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Affiliation(s)
- Ramkrishna Mondal
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Siddharth Mishra
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Jawahar S K Pillai
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Mukunda C Sahoo
- Department of Hospital Administration, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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16
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Das AK, Islam MN, Billah MM, Sarker A. COVID-19 pandemic and healthcare solid waste management strategy - A mini-review. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 778:146220. [PMID: 33711590 PMCID: PMC7932852 DOI: 10.1016/j.scitotenv.2021.146220] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/25/2021] [Accepted: 02/25/2021] [Indexed: 05/09/2023]
Abstract
Healthcare waste comprises the waste generated by healthcare facilities, medical laboratories and biomedical research facilities. Improper treatment of this waste poses serious risks of disease transmission to waste pickers, waste workers, health workers, patients, and the community in general through exposure to infectious agents. Poor management of the waste emits harmful and deleterious contaminants into society. However, contamination of highly contagious agents such as the COVID-19 virus has created enormous instability in healthcare waste handling and subsequent recycling because of the volume of the waste generated and its contagious nature. Several countries have adopted safety measures to combat this contamination and manage healthcare waste; however, these measures are insufficient and vary depending on the context of the country. In addition, the WHO has set out guidelines for management of healthcare waste. These guidelines are helping to manage the highly contagious healthcare waste resulting from the current pandemic. Proper healthcare waste management may add value by reducing the spread of the COVID-19 virus and increasing the recyclability of materials instead of sending them to landfill. Disinfecting and sorting out healthcare waste facilitates sustainable management and allows their utilization for valuable purposes. This review discusses the different healthcare solid waste management strategies practiced in different countries, the challenges faced during this management, and the possible solutions for overcoming these challenges. It also provides useful insights into healthcare solid waste management scenarios during the COVID-19 pandemic and a possible way forward.
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Affiliation(s)
- Atanu Kumar Das
- Department of Forest Biomaterials and Technology, Swedish University of Agricultural Sciences, SE-90183 Umeå, Sweden.
| | - Md Nazrul Islam
- Forestry and Wood Technology Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Md Morsaline Billah
- Biotechnology and Genetic Engineering Discipline, Khulna University, Khulna 9208, Bangladesh
| | - Asim Sarker
- Umeå International School of Public Health, Umeå University, SE-90187 Umeå, Sweden
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17
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A Roadmap for Environmental Sustainability of Plastic Use in Anesthesia and the Perioperative Arena. Anesthesiology 2021; 135:729-737. [PMID: 34237126 DOI: 10.1097/aln.0000000000003845] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fraifeld A, Rice AN, Stamper MJ, Muckler VC. Intraoperative waste segregation initiative among anesthesia personnel to contain disposal costs. WASTE MANAGEMENT (NEW YORK, N.Y.) 2021; 122:124-131. [PMID: 33513532 DOI: 10.1016/j.wasman.2021.01.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 11/18/2020] [Accepted: 01/06/2021] [Indexed: 06/12/2023]
Abstract
Approximately 90% of medical waste generated in the operating room (OR) is considered to be non-infectious and non-regulated (Wyssusek, Keys & van Zundert, 2019). Frequently, this waste is inappropriately disposed of into infectious regulated medical waste containers. Due to differences in waste treatment, improper segregation can lead to the misuse or inappropriate allocation of resources, environmental pollution, and increased cost for institutions. A waste segregation initiative was instituted in a tertiary care medical center in the anesthesia work-space of 35 ORs. This initiative included education of medical waste management to increase anesthesia staff knowledge and compliance with waste segregation and optimization of existing waste disposal containers to decrease waste disposal costs. After implementation, there was an increase in overall provider knowledge (p < 0.001) particularly in the categories of medication vial disposal, medication disposal and identification of items for disposal in the sharps containers (p ≤ 0.05). Data suggests a 34.7% increase in providers reporting to always practice waste segregation (p ≤ 0.05). Additionally, there was a statistically significant decrease in overall weight of regulated medical waste items from 0.33 kg/case to 0.09 kg/case (p < 0.001). This decrease in regulated waste supports an improvement in waste segregation and inappropriate items being disposed of in the general trash container. The omission of inappropriate waste was further confirmed by a segregation audit that showed an overall increase in correctly segregated regulated waste of 65%. Collectively, this lead to a cost savings of $15.60 per OR per week, or $28,392 annually.
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Affiliation(s)
- Anna Fraifeld
- Nurse Anesthesia Program, Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, United States
| | - Andi N Rice
- Nurse Anesthesia Program, Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, United States
| | - Matthew J Stamper
- Anesthesia Services, Prisma Health Upstate - GMMC, 701 Grove Rd., Greenville, SC, 29605, United States
| | - Virginia C Muckler
- Nurse Anesthesia Program, Duke University School of Nursing, 307 Trent Dr., Durham, NC 27710, United States.
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Robat DS, Sany SBT, Siuki HA, Peyman N, Ferns G. Impact of an Educational Training on Behavioral Intention for Healthcare Waste Management: Application of Health Action Model. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 42:272684X20982595. [PMID: 33632024 DOI: 10.1177/0272684x20982595] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Inappropriate healthcare waste management (HCWM) may lead to health hazards through the release of toxic and infectious agents into the environment. This study aimed to assess the appropriateness of a Health Action Model (HAM) operationalized in a training intervention to promote behavioral intent towards HCWM practice among hospital staff. This was a quasi-experimental intervention study of 128 hospital staff attending a training intervention in Sabzevar Hospital, Iran. Four training intervention was carried out using potential constructs of the HAM model to compare the quality of HCWM process and behavioral intent of hospital staff before and after a training session. A questionnaire based on HAM and multiple statistical analyses were used to assess the effectiveness of the training intervention. The average age of the eligible participants was 35.05 ± 9.4 years. A majority of the participant was married (88%), nursing staff (54%) and possessed a bachelor's degree (66%) or diploma (18%). After the intervention, a significant change (p < 0.05) was observed in the intervention group compared to the control group in staff knowledge, attitude, self-efficacy, belief, and motivation. Further, our result showed a significant improvement from 53.6 ± 24.3 to 83.6 ± 11.5 in the behavioral intention toward HCWM practice. This work provides evidence of the effectiveness of the HAM as a guide in which the potential determinates that influence an individual's behavioral intention toward medical waste practice were identified and described. This model help promote behavioral intention at a variety of target audiences and setting in waste management practice.
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Affiliation(s)
- Davoud Sarpooshi Robat
- Social Determinants of Health Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Seyedeh Belin Tavakoly Sany
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hadi Alizadeh Siuki
- Social Determinants of Health Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Science, Torbat Heydariyeh, Iran
| | - Nooshin Peyman
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
- Department of Health Education and Health Promotion, Faculty of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon Ferns
- Department of Public Health, School of Health, Torbat Heydariyeh University of Medical Science, Torbat Heydariyeh, Iran
- Department of Medical Education Brighton and Sussex Medical School, University of Brighton Falmer Campus, Brighton, UK
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20
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Amariglio A, Depaoli D. Waste management in an Italian Hospital's operating theatres: An observational study. Am J Infect Control 2021; 49:184-187. [PMID: 32663495 DOI: 10.1016/j.ajic.2020.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Each day operating theatres produce lots of waste. The wrong segregation represents both an environmental and economic problem, which is reflected in increased disposal cost and in a loss of resources. AIM To examine waste segregation by medical and nonmedical healthcare personnel in an Italian hospital's operating theatres. METHODS We used an observational tool, according to the local regulations and validated by a panel of experts. RESULT Fifty-seven percent of waste were disposed of incorrectly, of these 71% could have been recycled and 1% recovered. The preoperative phase had the greatest production of waste (48%) and the highest percentage of incorrect differentiation (72%). Sixty-six percent of waste handled as "undifferentiated" could have been recycled. Waste managed as hazardous that could have been recycled, reused or otherwise segregated stood at 54%. Hazardous waste was managed incorrectly in 5% of the disposals. CONCLUSION The lack of a variety of bins for waste segregation and improper classification by personnel appear to be the cause of the incorrect segregation, which should be error free.
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21
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Shaheen T, Ghani M, Kausar S. Gauging the Effectiveness of Training Sessions Among Nurses Regarding Biomedical Waste Management: A Quasi-Experimental Study From a Developing Country. Cureus 2020; 12:e12196. [PMID: 33489605 PMCID: PMC7815300 DOI: 10.7759/cureus.12196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Introduction Biomedical waste management (BWM) plays a crucial role in maintaining human and environmental health. Unfortunately, health-care workers (HCWs) lack the essential awareness concerning BWM and there is a dire need to adopt different strategies to improve their practices. This research aims to evaluate the effectiveness of training sessions among HCWs regarding biomedical waste management using a quasi-experimental study design. Methods This quasi-experimental study included a total of 64 nurses, selected with a systematic random sampling technique. Three days of structured training sessions were organized in the morning and evening shifts. Pertinently, pre-test and post-test were organized before and after the end of training sessions. Practices of nurses regarding BWM were also assessed before the training and after one month of training with the aid of a checklist. Results The low pre-test scores of the study participants elucidated insufficient knowledge regarding various aspects of BWM. After the three days of the structured training sessions, the analysis of post-test scores elucidated a marked improvement in the knowledge of the study participants. The practices of nurses regarding BWM were inappropriate; however, one month after the training sessions, the re-evaluation of practices showed a significant improvement. Conclusion The study showed that nurses had poor knowledge regarding BWM and were significantly improved on teaching interventions. An essential knowledge regarding BWM is therefore very useful for HCWs to protect themselves from infectious diseases. The inclusion of regular training sessions in the teaching curriculum can ensure adherence to guidelines for appropriate BWM. Assurance of ideal practices for BWM plays a key role in the prevention of nosocomial infection among HCWs.
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Affiliation(s)
| | - Mansoor Ghani
- Internal Medicine, University of Health Sciences, Lahore, PAK
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22
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Ashtari A, Sadegh Tabrizi J, Rezapour R, Rashidian Maleki M, Azami-Aghdash S. Health Care Waste Management Improvement Interventions Specifications and Results: A Systematic Review and Meta-Analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:1611-1621. [PMID: 33643934 PMCID: PMC7898106 DOI: 10.18502/ijph.v49i9.4074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Given the importance of proper management of Health Care Waste Management (HCWM), comprehensive information on interventions in this field is necessary. Therefore, we aimed to systematically review and meta-analysis of characteristics and results of interventions in the field of HCWM. Methods The required data were gathered through searching the keywords such as waste management, biomedical waste, hospitals waste, health care waste, infectious waste, medical waste, Waste Disposal Facilities, Garbage, Waste Disposal Facilities, Hazardous Waste Sites in PubMed, Scopus, EMBASE, Google scholar, Cochrane library, Science Direct, web of knowledge, SID and MagIran and hand searching in journals, reference by reference, and search in Gray literatures between 2000 and 2019. CMA software: 2 (Comprehensive Meta-Analysis) was used to perform the meta-analysis. Results Twenty-seven interventions were evaluated. Most of the studies were conducted after 2010, in the form of pre and post study, without control group, and in hospital. Interventions were divided into two categories: educational interventions (19 studies) and multifaceted managerial interventions (8 studies). The most studied outcome (in 11 studies) was KAP (knowledge, attitude and practice). The mean standard difference of interventions on KAP was estimated 3.04 (2.54-3.54) which was significant statistically (P<0.05). Also, interventions were considerably effective in improving the indicators of waste production amount, waste management costs and overall waste management performance. Conclusion Despite positive effect of interventions, due to the methodological deficiencies of published studies and high heterogeneity in results of studies, caution should be exercised in interpreting and using the results of the studies.
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Affiliation(s)
- Ali Ashtari
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Jafar Sadegh Tabrizi
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Ramin Rezapour
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Rashidian Maleki
- Tabriz Health Services Management Research Center, Health Management and Safety Promotion Research Institute, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Saber Azami-Aghdash
- School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran.,Iranian Center of Excellence in Health Management, School of Health Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, Iran
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Waste Segregation FMEA Model Integrating Intuitionistic Fuzzy Set and the PAPRIKA Method. MATHEMATICS 2020. [DOI: 10.3390/math8081375] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Segregation is an important step in health care waste management. If done incorrectly, the risk of preventable infections, toxic effects, and injuries to care and non-care staff, waste handlers, patients, visitors, and the community at large, is increased. It also increases the risk of environmental pollution and prevents recyclable waste from being recovered. Despite its importance, it is acknowledged that poor waste segregation occurs in most health care organizations. This study therefore intends to produce, for the first time, a classification of failure modes related to segregation in the Nuclear Medicine Department of a health care organization. This will be done using Failure Mode and Effects Analysis (FMEA), by combining an intuitionistic fuzzy hybrid weighted Euclidean distance operator, and the multicriteria method Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA). Subjective and objective weights of risk factors were considered simultaneously. The failure modes identified in the top three positions are: improper storage of waste (placing items in the wrong bins), improper labeling of containers, and bad waste management (inappropriate collection periods and bin set-up).
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Beloeil H, Albaladejo P. Initiatives to broaden safety concerns in anaesthetic practice: The green operating room. Best Pract Res Clin Anaesthesiol 2020; 35:83-91. [PMID: 33742580 DOI: 10.1016/j.bpa.2020.07.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 11/28/2022]
Abstract
The health sector is a major contributor to climate change through its large carbon footprint. Hospitals are highly energy and resource intensive. Operating rooms (ORs) contribute to a major part of these emissions because of anaesthetic gases, energy-intensive equipment and waste. Besides initiatives aimed to mitigate hospitals' climate footprints, health care professionals need to be involved in this process by changing their professional and personal behaviours without compromising the quality of care. Education on metrics (greenhouse gases), concepts (life cycle) and strategies to reduce the health care footprint would help professionals to commit themselves to the issue. The 5R's rule (reduce, reuse, recycle, rethink and research) used to promote an environmentally friendly way of life can be applied to the medical field and especially to the operating room and anaesthesia. When applied in the ORs, these strategies help question the use of disposable devices, attires and packaging, as well as our professional and personal behaviour. Greening the ORs requires the engagement of all professionals as well as other departments (pharmacy, hygiene) and management. Economic and social co-benefits are expected from this process.
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Affiliation(s)
- Helene Beloeil
- University of Rennes, CHU Rennes, Inserm, INRA, CIC 1414 NuMeCan, Anaesthesia and Intensive Care Department, F-35000 Rennes, France
| | - Pierre Albaladejo
- Grenoble Alpes University Hospital, ThEMAS/TIMC, CNRS 5525, Anaesthesia and Critical Care Department, F-38043, Grenoble, France.
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Shum PL, Kok HK, Maingard J, Schembri M, Bañez RMF, Van Damme V, Barras C, Slater LA, Chong W, Chandra RV, Jhamb A, Brooks M, Asadi H. Environmental sustainability in neurointerventional procedures: a waste audit. J Neurointerv Surg 2020; 12:1053-1057. [DOI: 10.1136/neurintsurg-2020-016380] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/17/2020] [Accepted: 06/17/2020] [Indexed: 11/04/2022]
Abstract
BackgroundOperating rooms contribute between 20% to 70% of hospital waste. This study aimed to evaluate the waste burden of neurointerventional procedures performed in a radiology department, identify areas for waste reduction, and motivate new greening initiatives.MethodsWe performed a waste audit of 17 neurointerventional procedures at a tertiary-referral center over a 3-month period. Waste was categorized into five streams: general waste, clinical waste, recyclable plastic, recyclable paper, and sharps. Our radiology department started recycling soft plastics from 13 December 2019. Hence, an additional recyclable soft plastic waste stream was added from this time point. The weight of each waste stream was measured using a digital weighing scale.ResultsWe measured the waste from seven cerebral digital subtraction angiograms (DSA), six mechanical thrombectomies (MT), two aneurysm-coiling procedures, one coiling with tumour embolization, and one dural arteriovenous fistula embolization procedure. In total, the 17 procedures generated 135.3 kg of waste: 85.5 kg (63.2%) clinical waste, 28.0 kg (20.7%) general waste, 14.7 kg (10.9%) recyclable paper, 3.5 kg (2.6%) recyclable plastic, 2.2 kg (1.6%) recyclable soft plastic, and 1.4 kg (1.0%) of sharps. An average of 8 kg of waste was generated per case. Coiling cases produced the greatest waste burden (13.1 kg), followed by embolization (10.3 kg), MT (8.8 kg), and DSA procedures (5.1 kg).ConclusionNeurointerventional procedures generate a substantial amount of waste, an average of 8 kg per case. Targeted initiatives such as engaging with suppliers to revise procedure packs and reduce packaging, digitizing paper instructions, opening devices only when necessary, implementing additional recycling programs, and appropriate waste segregation have the potential to reduce the environmental impact of our specialty.
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Wyssusek KH, Keys MT, van Zundert AAJ. Operating room greening initiatives - the old, the new, and the way forward: A narrative review. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2019; 37:3-19. [PMID: 30132405 DOI: 10.1177/0734242x18793937] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Healthcare waste is a rampant issue in Australian hospitals. The operating room (OR) contributes disproportionately to total hospital waste. There has been considerable research in the literature concentrating on strategies to improve OR and hospital waste accumulation, in an attempt to provide guidance and direction on how to reduce the healthcare ecological footprint. We reviewed the literature for leading greening initiatives currently utilised in the OR in Australia and internationally. This narrative literature review focuses on the trend of OR greening initiatives over the last 25 years, comparing different innovative approaches, the successes and setbacks, and the financial implications of initiatives. A variety of measures that hospital management, surgeons, anaesthetists, nurses and other healthcare personnel can take to reduce the ecological footprint of their healthcare facility are outlined. Greening initiatives include reducing, recycling, reusing, rethinking and researching, as well as novel technology and smarter architectural design. We also evaluated the barriers to improving waste management, which include lack of leadership, misconceptions among staff, and an overall resistance to change. In conclusion, in a world where greenhouse gas emissions cause unprecedented climate change and landfill space is finite, it is incumbent upon hospitals to help reduce the environmental impact of their facility. Reducing pollution and greenhouse gas emissions would moderate the incidence of human disease, save money for the healthcare system and society as a whole, and contribute to a safer and healthier world we all would like to live in.
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Affiliation(s)
- Kerstin H Wyssusek
- 1 Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Australia
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Maggie T Keys
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
- 3 Department of Medicine, Royal Brisbane and Women's Hospital, Australia
| | - André A J van Zundert
- 1 Department of Anaesthesia and Perioperative Medicine, Royal Brisbane and Women's Hospital, Australia
- 2 Faculty of Medicine, University of Queensland, Brisbane, Australia
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Ghasemi L, Yousefzadeh S, Rastkari N, Naddafi K, Shariati Far N, Nabizadeh R. Evaluate the types and amount of genotoxic waste in Tehran University of Medical Science's hospitals. JOURNAL OF ENVIRONMENTAL HEALTH SCIENCE & ENGINEERING 2018; 16:171-179. [PMID: 30728989 PMCID: PMC6277331 DOI: 10.1007/s40201-018-0305-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 05/06/2018] [Indexed: 05/03/2023]
Abstract
PURPOSE Genotoxic wastes are one type of hospital wastes that are extremely dangerous and may cause cell mutation or cancer and their disposal should be taken seriously. Cytotoxic drugs are main component of these wastes. The purpose of this study was to determine the types and quantities of genotoxic wastes in hospitals of Tehran University of Medical Sciences and evaluation of genotoxic waste management index. METHODS For this purpose, a questionnaire was used to collect data. Each question was scored according to compliance or non-compliance with the law, and genotoxic hospital waste management index was calculated for each hospital. RESULTS Various parameters including waste generation rate, segregation, collection, transportation, storage, disposal and the hygiene of personnel were evaluated. The results showed that 60% of hospitals ranked medium, 27% ranked poor and 13% ranked as very poor according to this index. CONCLUSIONS Since the condition of genotoxic waste management in this study was ranked as medium, therefore some steps of hospital waste management system require improvement.
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Affiliation(s)
- Leila Ghasemi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Samira Yousefzadeh
- Department of Environmental Health Engineering, Aradan School of Public Health and Paramedical, Semnan University of Medical Sciences, Semnan, Iran
- Students’ Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Noushin Rastkari
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Kazem Naddafi
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nabi Shariati Far
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ramin Nabizadeh
- Department of Environmental Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
- Center for Air Pollution Research, Institute for Environmental Research, Tehran University of Medical Sciences, Tehran, Iran
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Vaccari M, Tudor T, Perteghella A. Costs associated with the management of waste from healthcare facilities: An analysis at national and site level. WASTE MANAGEMENT & RESEARCH : THE JOURNAL OF THE INTERNATIONAL SOLID WASTES AND PUBLIC CLEANSING ASSOCIATION, ISWA 2018; 36:39-47. [PMID: 29132259 DOI: 10.1177/0734242x17739968] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
Given rising spend on the provision of healthcare services, the sustainable management of waste from healthcare facilities is increasingly becoming a focus as a means of reducing public health risks and financial costs. Using data on per capita healthcare spend at the national level, as well as a case study of a hospital in Italy, this study examined the relationship between trends in waste generation and the associated costs of managing the waste. At the national level, healthcare spend as a percentage of gross domestic product positively correlated with waste arisings. At the site level, waste generation and type were linked to department type and clinical performance, with the top three highest generating departments of hazardous healthcare waste being anaesthetics (5.96 kg day-1 bed-1), paediatric and intensive care (3.37 kg day-1 bed-1) and gastroenterology-digestive endoscopy (3.09 kg day-1 bed-1). Annual overall waste management costs were $US5,079,191, or approximately $US2.36 kg-1, with the management of the hazardous fraction of the waste being highest at $US3,707,939. In Italy, reduction in both waste arisings and the associated costs could be realised through various means, including improved waste segregation, and linking the TARI tax to waste generation.
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Affiliation(s)
- Mentore Vaccari
- 1 Department of Civil, Environmental, Architectural Engineering and Mathematics, University of Brescia, Brescia, Italy
| | - Terry Tudor
- 2 The School of Science and Technology, University of Northampton. Northampton, UK
| | - Andrea Perteghella
- 1 Department of Civil, Environmental, Architectural Engineering and Mathematics, University of Brescia, Brescia, Italy
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Improving Staff Knowledge of Perioperative Regulated-Waste Management. AORN J 2017; 105:85-91. [PMID: 28034404 DOI: 10.1016/j.aorn.2016.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Revised: 04/17/2016] [Accepted: 11/07/2016] [Indexed: 11/20/2022]
Abstract
The mismanagement of regulated waste is a costly issue for many health care facilities. Our facility undertook a quality improvement project to determine whether increasing staff members' knowledge of regulated-waste management would reduce its mismanagement in the surgical setting. I designed a mandatory online learning module for all perioperative staff members and obtained consent from participants to use their test scores. I also designed pre- and posteducation audits to identify the total mass of regulated waste produced in the department and to categorize which items were nonregulated according to facility standards. Personnel achieved a 41% reduction in the total mass of regulated waste sampled and a 77% reduction in nonregulated item mass. The results of the audits determined that perioperative staff members are more likely to improve compliance with the disposal of regulated waste after increasing their knowledge base.
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