Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia

Effective Medical Waste Management for Sustainable Green Healthcare

This study examines the importance of medical waste management activities for developing a sustainable green healthcare environment. This study applied a multiple methodological approach as follows. A thorough review of the literature was performed to delineate the factors that have been explored for reducing medical waste; hospital staff who handle medical waste were surveyed to obtain their opinions on these factors; the analytic hierarchy process (AHP) was applied to determine the priorities among the identified key factors; and experts' opinions were consulted to assess the actual applicability of the results derived by the AHP. The study identified the following factors as the most important: medical waste management (26.6%), operational management issues (21.7%), training for medical waste management procedures (17.8%), raising awareness (17.5%), and environmental assessment (16.4%). This study analyzed the contributing factors to the generation of medical waste based on the data collected from medical staff and the AHP for developing a sustainable green healthcare environment. The study results provide theoretical and practical implications for implementing effective medical waste management toward a sustainable green healthcare environment.

Healthcare waste generation in hospitals per continent: a systematic review

There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

Transforming the vaccine supply chain in Australia: Opportunities and challenges

BACKGROUND

Analyzing potential benefits of thermostable vaccines delivered through Micro Array Patch (MAP) has received great attention in low and middle-income countries. The experience may or may not be the same in developed countries where the infrastructure is more developed. It is anticipated that transforming the vaccine supply chain from syringe-and-needle to thermostable MAP-delivered vaccines will result in reduced supply chain costs - including manufacturing/supply, logistics/distribution, and administration costs - as well as reduced wastes and improved safety. This paper provides an end-to-end supply chain analysis comparing the key aspects (cost, safety and environmental aspects) of the conventional syringe-and-needle vaccine supply chain with those of the MAP vaccine supply chain for influenza vaccine delivery in Australia. Directions for future research in this area will be provided.

OBJECTIVE

To determine the potential supply chain impacts of replacing syringe-and-needle flu vaccine with MAP-enabled thermostable flu vaccine in Australia.

METHODS

We analyze the current flu vaccine supply chain in Australia to identify practical limitations and opportunities for improvement. Data/information is collected through interviewing the key stakeholders across vaccine supply chain including vaccine manufacturers, logistics providers, clinics, hospitals, and pharmacies.

FINDINGS

A detailed practice-informed analysis is completed on the key operations of the flu vaccine supply chain. Barriers and limitations of the conventional flu vaccine are discussed, along with potential improvements that can be achieved through the implementation of MAP-enabled flu vaccine delivery. We discuss how technology-driven innovations can help advance vaccine supply chains, improve vaccine visibility, reduce wastes, and enable informed decision-making.

CONCLUSION

We find that the benefits of moving from syringe-and-needle vaccines to thermostable MAP-delivered vaccines are beyond transportation and storage cost saving. Potential benefits through cost saving, waste reduction, and service level improvement are discussed along with various safety and wellbeing consequences followed by directions for future research in this area.

Current practices of waste management in teaching hospitals and presence of incinerators in densely populated areas

BACKGROUND

Hospital waste management (HWM) practices are the core need to run a proper health care facility. This study encompasses the HWM practices in teaching hospitals of Peshawar, Pakistan and examine the enforcement of Pak HWM (2005) rules and risks through transmission of pathogens via blood fluids, air pollution during waste incineration and injuries occurring in conjunction with open burning and dumping.

METHODS

A questionnaire based on World Health Organization (WHO) recommendations was used to survey the selected private and public teaching hospital (n = 16). Site visits and personnel observations were also included in the data. It was spatio-statistically analyzed using descriptive statistics, Krushkal-wallis and Fisher's exact tests.

RESULTS

The findings revealed that the lack of HWM practices in all surveyed hospitals (p > 0.05), besides statistical difference (p < 0.017) in waste generation/day. No proper segregation of waste from generation point to final disposal was practiced. However, the performance of private teaching hospitals (50%) was found better in terms of HWM personnel and practices. In surveyed hospitals, only nine hospitals (56.3%) were found with the incinerator facility while rest of the hospitals (43.7%) practiced open dumping. Moreover, operational parameters of the incinerators were not found satisfactory and located in densely populated areas and emitting hazardous gases.

CONCLUSION

Proper HWM practices are not being followed in the light of WHO guidelines. Hospital waste impose serious menace to healthcare workers and to nearby population. WHO issued documents for improving HWM practices but triggered no change in Pakistan. To improve the situation, insights in this context is need for enforcement of rules.

Practices of Healthcare Workers regarding Infection Prevention in Bale Zone Hospitals, Southeast Ethiopia

Introduction. In Ethiopia, infection prevention to protect patients, healthcare workers, and visitors from healthcare-acquired infections is one of a number of nationwide transformational initiatives to ensure the provision of quality healthcare services. The aim of this research was to assess the practice of healthcare workers regarding infection prevention and its associated factors in Bale zone Hospitals. Methods. A cross-sectional study targeted 402 healthcare workers using simple random sampling to learn about their practices related to infection prevention. Data were collected in interviews using pretested, structured questionnaires. Returned questionnaires were checked for completeness and then data were entered into a database and analyzed using SPSS Version 20. Adjusted odd ratio (AOR) with a 95% confidence interval was calculated to determine the strength of association, and variables with a p value <0.05 in the final model were considered as statistically significant. Results. Three hundred ninety-four healthcare workers participated in the study. Of these; 145 (36.8%, 95% CI 32, 42%) of them were found to have self-reported good infection prevention practice. Good knowledge towards infection prevention (AOR = 1.84, 95% CI 1.02, 3.31), availability of personal protective equipment (AOR = 1.96, 95% CI 1.16, 3.32), and water (AOR = 4.42, 95% 2.66, 7.34) at workplace were found to have a statistically significant association with healthcare workers self-reported good infection prevention practices. Conclusions. In this study, slightly more than one-third of the healthcare workers reported to have good infection prevention practice. Good knowledge towards infection prevention, working in departments, availability of personal protective equipment, and water at work place were found to have statistically significant association with self-reported good infection prevention practices.

Self-reported healthcare waste segregation practice and its correlate among healthcare workers in hospitals of Southeast Ethiopia

BACKGROUND

The key to the effective management of healthcare wastes is segregation of the waste at the point of generation; no matter what final strategy for treatment and disposal of wastes is selected, it is critical that waste streams are separated. In Ethiopia, healthcare waste segregation practice among healthcare workers is overlooked and scarcely addressed in the scientific literature. This hospital-based cross-sectional study was, therefore, conducted to assess healthcare waste segregation practice and its correlate among healthcare workers in Bale zone, southeast Ethiopia.

METHODS

All five hospitals found in Bale zone were included and the study participants were selected using a systematic sampling technique from each hospital. Data were collected through interview using structured questionnaires. Descriptive statistics were computed. Bivariate and multivariable logistic regression analyses were employed to identify factors that correlate with healthcare waste segregation practice.

RESULTS

A total of four hundred and nine healthcare workers participated in the study, for a response rate of 97.4%. Of these, 220(53.8%) (95% CI: 49.1-58.9) of healthcare workers were found to have reported good healthcare waste segregation practice. Being male gender (AOR = 1.70, 95%CI: 1.04-2.78), less than 30 years of age (AOR = 2.02, 95%CI: 1.06-3.84), less than 2 years work experience (AOR = 2.95, 95%CI: 1.39-6.26), having good self-reported standard precaution practice (AOR = 8.47,95%CI:4.98-14.42), and working in a department with an on-site healthcare waste segregation container (AOR = 2.10, 95%CI:1.24-3.55) were factors that correlated with self-reported healthcare waste segregation practice.

CONCLUSION

Overall, only half of the healthcare workers had good healthcare waste segregation practice, which is low and unsatisfactory. Less service year, having good standard precaution practice, and the presence of onsite waste segregation container were the most important variables that correlate with self-reported healthcare waste segregation practice. Therefore, to improve healthcare waste segregation practice health authorities should focus on sufficient allocation of onsite waste receptacles. In addition, periodic training on standard precaution will improve compliance with segregation practice.

Healthcare waste management current status and potential challenges in Ethiopia: a systematic review

Objective

During the healthcare delivery process, hazardous wastes can be generated from the health facilities. Improper healthcare waste management is responsible for the transmission of more than 30 dangerous bloodborne pathogens. The aim of this systematic review was to evaluate the healthcare waste management practice and potential challenges in Ethiopia.

Results

Electronic databases and direct Google search yielded 1742 articles from which 17 studies met the inclusion criteria. The proportion of hazardous waste generated in Ethiopian healthcare facilities was unacceptably high which ranged from 21 to 70%. Most studies indicated the absence of proper waste segregation practice at the source of generation. Treatment of the healthcare waste using low combustion incinerator and/or open burning and open disposal of the incinerator ash were very common. Lack of awareness from the healthcare staff, appropriate waste management utilities and enforcement from the regulatory bodies were mainly identified as a common factor shared by most of the studies. The healthcare waste management practice in Ethiopian healthcare facilities was unsatisfactory. There should be close supervision of the waste disposal process by the regulatory bodies or other stakeholders.

Assessment of Knowledge, Attitude, and Practice about Biomedical Waste Management and Associated Factors among the Healthcare Professionals at Debre Markos Town Healthcare Facilities, Northwest Ethiopia

Background

Healthcare activities restore health and save lives at the same time; however, they can generate hazardous biomedical wastes to a human being or the environment. Generation and disposal of biomedical wastes have become an emerging problem worldwide.

Objective

To assess knowledge, attitude, and practice about biomedical waste management and associated factors among healthcare professionals in Debre Markos town healthcare facilities, northwest Ethiopia.

Methods

A cross-sectional study was employed, and data were collected through structured self-administered questionnaire and observational checklist. Data were entered into the Epi-data 3.1 software and exported into SPSS version 20 for analysis. Bivariate and multivariate logistic regression analyses were computed. Variables with a P value of <0.05 in the multivariate logistic regression analysis were considered to explain the presence of statistically significant associations.

Result

Among 296 healthcare professionals studied, 168 (56.8%), 196 (66.2%), and 229 (77.4%) had adequate knowledge, favorable attitude, and adequate practice score, respectively. Regarding associated factors, MSc and MD+ (AOR: 4, 95% CI: (1.37, 149.52)), BSc holders (AOR: 2.53, 95% CI: (1.47, 4.38)), and availability of color-coded bins (AOR: 7.68, 95% CI: (3.30, 17.89)) were identified more likely to contribute for adequate knowledge, favorable attitude, and adequate practice scores, respectively.

Conclusion

The level of knowledge, attitude, and practice scores were not satisfactory. Majority of the healthcare professionals did not access biomedical waste management training. Educational level, use of visual aid, and availability of color-coded bins in the department were identified as a factor for biomedical waste management. Regular training should be given to healthcare professionals.

Generation and composition of waste from medical histopathology laboratories

The aim of this work was to record the quantities and composition of medical waste (MW) generated by public and private medical histopathology laboratories (HISTOLB) and to provide pertinent waste generation design coefficients (e.g. g/examinee) for those laboratories. This can be a useful coefficient when designing medical waste treatment facilities. The study was conducted on three public and four private HISTOLBs in the city of Thessaloniki (Greece) for a period of 5 months. One sampling week was selected randomly per month. During the study period, the examinees per week were 108 and 90 in the public and private HISTOLBs, respectively. According to the results, 57% of the total MW generated in both the public and private laboratories were toxic waste (TXW), namely the liquid formaldehyde that is used to preserve the tissue. The mixed hazardous waste (MHW) comprised 28% and 24%, respectively, of the total MW, in the public and private facilities, respectively. The infectious waste constituted around 15% of the total MW generated in both types of facilities. Urban type waste was always less than 4% by weight. The total mean MW generated in the public and private laboratories were 208 ± 543 (n = 1614) and 195 ± 512 (n = 1789) g/examinee, respectively. A large variance among the mean MW generation rates of the participating individual laboratories that belonged to the same category was observed. The dominant fraction of the infectious waste was the plastic containers that contained the tissue samples, being around 75% of the total infectious waste, followed by the latex gloves (being around 17% of the infectious waste).

Investigating motivating factors for sound hospital waste management

Sustainable management of hospital waste requires an active involvement of all key players. This study aims to test the hypothesis that three motivating factors, namely, Reputation, Liability, and Expense, influence hospital waste management. The survey for this study was conducted in two phases, with the pilot study used for exploratory factor analysis and the subsequent main survey used for cross-validation using confirmatory factor analysis. The hypotheses were validated through one-sample t tests. Correlations were established between the three motivating factors and organizational characteristics of hospital type, location, category, and size. The hypotheses were validated, and it was found that the factors of Liability and Expense varied considerably with respect to location and size of a hospital. The factor of Reputation, however, did not exhibit significant variation. In conclusion, concerns about the reputation of a facility and an apprehension of liability act as incentives for sound hospital waste management, whereas concerns about financial costs and perceived overburden on staff act as disincentives.

IMPLICATIONS

This paper identifies the non economic motivating factors that can be used to encourage behavioral changes regarding waste management at hospitals in resource constrained environments. This study discovered that organizational characteristics such as hospital size and location cause the responses to vary among the subjects. Hence a policy maker must take into account the institutional setting before introducing a change geared towards better waste management outcomes across hospitals. This study covers a topic that has hitherto been neglected in resource constrained countries. Thus it can be used as one of the first steps to highlight and tackle the issue.

Healthcare waste management research: A structured analysis and review (2005-2014)

The importance of healthcare waste management in preserving the environment and protecting the public cannot be denied. Past research has dealt with various issues in healthcare waste management and disposal, which spreads over various journals, pipeline research disciplines and research communities. Hence, this article analyses this scattered knowledge in a systematic manner, considering the period between January 2005 and July 2014. The purpose of this study is to: (i) identify the trends in healthcare waste management literature regarding journals published; (ii) main topics of research in healthcare waste management; (iii) methodologies used in healthcare waste management research; (iv) areas most frequently researched by researchers; and (v) determine the scope of future research in healthcare waste management. To this end, the authors conducted a systematic review of 176 articles on healthcare waste management taken from the following eight esteemed journals: International Journal of Environmental Health Research, International Journal of Healthcare Quality Assurance, Journal of Environmental Management, Journal of Hazardous Material, Journal of Material Cycles and Waste Management, Resources, Conservations and Recycling, Waste Management, and Waste Management & Research. The authors have applied both quantitative and qualitative approaches for analysis, and results will be useful in the following ways: (i) results will show importance of healthcare waste management in healthcare operations; (ii) findings will give a comparative view of the various publications; (c) study will shed light on future research areas.

The reality of waste management in primary health care units in Brazil

A large number of users are serviced in primary health care units in Brazil, both in health facilities and in households. These services generate waste that must be managed safely, but there is no legislation that regulates this type of waste management in Brazil. The objective of this study was to analyse the production and management of waste in primary health care. A direct observation was performed of the stages in the handling and weighing of waste generated in primary health care units in the municipality of Goiânia (Brazil). The units generated infectious, chemical, and common waste, as well as sharp objects. The generation of waste ranged between 0.027 and 0.075 kg user-day. The generated waste was classified mostly as common and recyclable. Flaws were observed in the management of all types of waste. The critical point is segregation. Only 34.1% of the waste disposed of as infectious actually belonged to this group, the rest was ordinary waste. Flaws at this stage increase the volume of infectious waste, the occupational and environmental risks, and associated costs. Intervention to change this reality is needed and it requires the careful preparation of a waste management plan, corroborating structural changes to the implementation of this plan, and professional training and public policies to guide waste management in primary care, especially those generated in households.