Assessment of Healthcare Waste Generation Rate and Its Management System in Health Centers of Bench Maji Zone

Healthcare waste generation and quantification in public health centres in Addis Ababa, Ethiopia

BACKGROUND

Healthcare waste produced in healthcare activities entails higher risk of infection and injuries than municipal waste. In developing countries healthcare waste has not received much attention and has been disposed of together with municipal wastes. Modern method of disposal of healthcare waste have been introduced to most healthcare institutions mismanagement and increased in production in public health centres in Ethiopia is important issues. The aim of the study was to assess the type of healthcare waste generation and quantification in selected public health centres in Addis Ababa, Ethiopia.

METHODS

An institution based cross-sectional study were conducted from January to February 2018. Fifteen health centres in Addis Ababa City Administration were selected for this study. Data were collected by using by different color plastic bags (Black plastic bags for non-hazardous wastes, Yellow plastic bags for hazardous wastes and Yellow safety box for needles and Red bags for pharmaceutical wastes and toxic wastes). The collected wastes were measured by weighing scale and were written to data entry sheet. To assure the data quality calibration of weighing scale was made by the standard weight every morning. EPI INFO TM7 and IBM SPSS were used for data entry, cleaning and analysis.

RESULTS

The mean healthcare waste generation was 10.64+5.79Kg/day of which 37.26% (3.96+2.20Kg/day) was general waste and 62.74% (6.68+4.29) was hazardous waste from the studies health centres. Total hazardous waste; sharps, infectious, pathological and pharmaceutical wastes constitutes mean (±SD) 0.97 ±1.03, 3.23 ± 2.60, 2.17±1.92 and 0.25 ±0.34 kg/day respectively. Healthcare waste 29.93% and 0.32% were generated from delivery and post-natal case team and nutrition and growth monitoring case team respectively. The annual mean+ SD of healthcare waste generation rate per health centres were 3807.53+ 2109.84 Kg/year.

CONCLUSION

The finding in this study showed there was an increased in hazardous healthcare waste in amount as compared to the WHO standard 85% non-hazardous waste and 10% hazardous waste and 5% toxic wastes. The healthcare waste management practices about segregation, collection, transportation and disposal at the source is crucial to decrease in quantity. Generally unselective handling and disposal of healthcare wastes is a concern.

Biomedical waste segregation compliance scoring system: to analyze, strengthen, monitor, and step up waste management in healthcare facilities

Introduction

segregation of biomedical waste (BMW) is the foremost and prime step for effective BMW management. This study was taken up to assess the BMW segregation compliance in patient care areas using a checklist-based scoring system to analyze the segregation compliance and establish feedback-based training programs.

Methods

this study was conducted between January 2020 to December 2021 at a government tertiary care hospital in Hyderabad. The compliance was calculated by giving a score of one for each day, such that if there was no noncompliance (NC) the score was 100% for a given location at the end of the month. A score of minus one was given for each day a noncompliance was noted and transfigured into percentages. A score of 100% was considered good, and below 95% was considered an action point necessitating root cause analysis and training.

Results

the BMW segregation compliance scores of the hospital for the year 2020 (96.5%) were compared with 2021 scores (97.5%). The outpatient department (OPD) and ICU had the poorest compliance rate of 93.7% and 93.6% respectively, compared to wards (96.2%). The most common factors influencing NC in BMW segregation were the joining of new staff, relocation, or new establishment of wards. The most common segregation error was found in the yellow disposal bags pertaining to the disposal of personal protective equipment.

Conclusion

this easy and simple scoring system was established to improve the segregation compliance of BMW. End of each month an area wise compliance is easily made such that areas with low scores could be trained.

Healthcare Waste Segregation Practice and Associated Factors among Healthcare Professionals Working in Public and Private Hospitals, Dire Dawa, Eastern Ethiopia

Background

The key to the effective management of healthcare wastes is the segregation of the waste at the point of generation; no matter what final strategy for the treatment and disposal of wastes is selected, it is critical that waste streams are separated.

Objective

The aim of the study is to assess the practice of healthcare waste segregation and associated factors among healthcare workers at public and private hospitals in Dire Dawa, Eastern Ethiopia.

Methods

An institution-based cross-sectional study was conducted among 280 healthcare workers from public and private hospitals. Data were collected through self-administered structured questionnaires and observation checklists. Bivariate and multivariable logistic regression were used to identify factors associated with the practice of healthcare workers using SPSS (Statistical Package for Social Sciences) version 25.

Results

This study showed that 56.4% (95% CI: 43.7-60.2) study participants had good healthcare waste segregation practices. Working in a public hospital (AOR = 0.09, 95% CI: (0.03-0.23)), working less than 40 hours a week (AOR = 4.28, 95% CI: (2.11-8.68)), adequate knowledge on healthcare waste management (AOR = 2.42, 95% CI: (1.27-4.61)), ever trained on waste management ((AOR = 2.74, 95% CI: (1.15-6.53)), the presence of guidelines, instructive posters on healthcare waste segregation ((AOR = 8.21, 95% CI: (3.84-17.55)), and availability of color-coded waste bins ((AOR = 9.53, 95% CI: (4.52-20.10)) were factors significantly associated with healthcare waste segregation practices.

Conclusion

The study revealed that healthcare waste segregation practices were unacceptably poor. It is very crucial to address the identified factors through ongoing enforcement of healthcare waste management rules and regulations, by providing training, instructive posters around the work area, and making color-coded bins available.

Healthcare Waste-A Serious Problem for Global Health

Healthcare waste (HCW) is generated in different healthcare facilities (HCFs), such as hospitals, laboratories, veterinary clinics, research centres and nursing homes. It has been assessed that the majority of medical waste does not pose a risk to humans. It is estimated that 15% of the total amount of produced HCW is hazardous and can be infectious, toxic or radioactive. Hazardous waste is a special type of waste which, if not properly treated, can pose a risk to human health and to the environment. HCW contains potentially harmful microorganisms that can be spread among healthcare personnel, hospital patients and the general public, causing serious illnesses. Healthcare personnel are the specialists especially exposed to this risk. The most common medical procedure, which pose the highest risk, is injection (i.e, intramuscular, subcutaneous, intravenous, taking blood samples). The World Health Organization (WHO) estimates that around 16 billion injections are administered worldwide each year. However, if safety precautions are not followed, and needles and syringes are not properly disposed of, the risk of sharps injuries increases among medical staff, waste handlers and waste collectors. What is more, sharps injuries increase the risk of human immunodeficiency virus (HIV), hepatitis B and C viruses (HBV/HCV), tuberculosis (TB), diphtheria, malaria, syphilis, brucellosis and other transmissions. Disposing of medical waste in a landfill without segregation and processing will result in the entry of harmful microorganisms, chemicals or pharmaceuticals into soil and groundwater, causing their contamination. Open burning or incinerator malfunctioning will result in the emission of toxic substances, such as dioxins and furans, into the air. In order to reduce the negative impact of medical waste, waste management principles should be formulated. To minimize health risks, it is also important to build awareness among health professionals and the general public through various communication and educational methods. The aim of this paper is to present a general overwiev of medical waste, its categories, the principles of its management and the risks to human health and the environment resulting from inappropriate waste management.

Waste audits in healthcare: A systematic review and description of best practices

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.

Knowledge, attitude and practice towards bio-medical waste management among healthcare workers: a northern Saudi study

Background

Health care workers (HCWs) involved in day-to-day care and other healthcare activities play a significant role in biomedical waste (BMW) management. The World Health Organization stated some of the causes for the failure of BMW management, namely, lack of awareness of the health hazards related to BMW and inadequate trained HCWs in BMW management. The present study assessed knowledge, attitude, and practice (KAP) towards BMW management among the HCWs in northern Saudi Arabia.

Methodology

The present study assessed KAP through a self-administered and validated questionnaire. Using a multistage probability sampling method, 384 HCWs from different healthcare facilities participated in this survey. We performed binomial logistic regression analysis to find association between KAP subscales and sociodemographic characteristics. Spearman's correlation test was performed to find the strength and direction of correlation (rho) between KAP scores.

Results

Of the population studied, high knowledge, attitude, and practice scores were found in 47.1%, 65.1%, and 49.5% of the HCWs, respectively. The present study found that knowledge score was significantly higher among the age group from 30 to 39 years (ref: age less than 30 years: AOR = 2.25, 95% CI [1.05-4.85], p = 0.04) and non- Saudi nationals (ref: Saudi: AOR = 2.84, 95% CI [1.63-4.94], p < 0.001) The attitude score towards BMW management was significantly lower among the HCWs working in tertiary care settings (ref: PHC: AOR = 0.38, 95% CI [0.12-0.69], p = 0.01). Regarding the practice score, the male categories had a significantly higher score (ref: female: AOR = 1.82, 95% CI [1.19 -2.99], p = 0.02), while pharmacist (ref: physicians: AOR = 0.39, 95% CI [0.18-0.58], p = 0.02) and lab technicians (ref: physicians: AOR = 0.31, 95% CI [0.11-0.53], p = 0.02) had a significant lower practice score. The test results revealed a weak positive correlation of knowledge with the attitude scores (rho = 0.249, p = 0.001), and a moderately strong positive correlation was found between attitude and practice scores (rho = 0.432, p = 0.001).

Conclusion

This study suggests that a regular training program for the HCWs on BMW management is necessary through symposiums, role play, interactive lectures, and other feasible training methods. Furthermore, a multicentric prospective exploratory study is to be conducted in other regions of the KSA to understand the region-specific training needs of HCWs.

Healthcare Waste Management Practices and Associated Factors in Private Clinics in Addis Ababa, Ethiopia

BACKGROUND

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes at point of generation. However, less attention is given to healthcare waste management in Ethiopia and there is no evidence about healthcare waste management practices in private clinics in Addis Ababa. Accordingly, this study was conducted to assess healthcare waste management practices and associated factors in private clinics in Addis Ababa, Ethiopia.

METHODS

A health facility-based cross-sectional study was conducted in 278 randomly selected private clinics in Addis Ababa. Data were collected using questionnaire and observational checklists. Multivariable binary logistic regression analysis was used to identify factors associated with healthcare waste management practices on the basis of adjusted odds ratio (AOR) with 95% confidence interval (CI) and P-values <.05.

RESULT

Results showed that 61.2% of the surveyed clinics had poor healthcare waste management practices, out of which, 56.8% had poor waste segregation practice, 55.0% had poor waste collection practice, 85.6% had poor waste transportation practice, 63.3% had poor waste storage practice, 61.9% had poor waste treatment, and 57.9% had poor disposal system. Healthcare waste management practice in the surveyed clinics was significantly associated with presence of guidelines (AOR: 1.98, 95% CI: 1.06, 3.69), budget allocation (AOR: 2.05, 95%, CI: 1.20, 3.49), and inspection by the regulatory bodies (AOR: 2.47, 95% CI: 1.26, 4.84).

CONCLUSION

Healthcare waste management practice was poor in the surveyed clinics. This suggests that the healthcare industries in the studied region may create health treats to healthcare workers, waste handlers, patients, the community, and the environment at large. The following key elements are needed to improve healthcare waste management practices in private clinics: promoting practices that reduce the volume of waste generated and ensure proper waste segregation; developing strategies and systems, as well as strong oversight and regulation, to incrementally improve waste segregation, destruction, and disposal practices with the ultimate goal of meeting national and international standards; and selecting safe and environmentally-friendly management options, to protect people from hazards when collecting, handling, storing, transporting, treating or disposing of waste.

Medical Waste Treatment Technologies for Energy, Fuels, and Materials Production: A Review

The importance of medical waste management has grown during the COVID-19 pandemic because of the increase in medical waste quantity and the significant dangers of these highly infected wastes for human health and the environment. This innovative review focuses on the possibility of materials, gas/liquid/solid fuels, thermal energy, and electric power production from medical waste fractions. Appropriate and promising treatment/disposal technologies, such as (i) acid hydrolysis, (ii) acid/enzymatic hydrolysis, (iii) anaerobic digestion, (vi) autoclaving, (v) enzymatic oxidation, (vi) hydrothermal carbonization/treatment, (vii) incineration/steam heat recovery system, (viii) pyrolysis/Rankine cycle, (ix) rotary kiln treatment, (x) microwave/steam sterilization, (xi) plasma gasification/melting, (xii) sulfonation, (xiii) batch reactor thermal cracking, and (xiv) torrefaction, were investigated. The medical waste generation data were collected according to numerous researchers from various countries, and divided into gross medical waste and hazardous medical waste. Moreover, the medical wastes were separated into categories and types according to the international literature and the medical waste fractions’ percentages were estimated. The capability of the examined medical waste treatment technologies to produce energy, fuels, and materials, and eliminate the medical waste management problem, was very promising with regard to the near future.

Reduction of Management Costs and Avoidance of Air Release of Carcinogens Through a Waste Segregation Program in a Brazilian Medical Institution

Hospital waste management is a current sustainability challenge. Although not always performed, the most applied approach in current protocols is the proper segregation of waste. The incineration of hospital waste is an significant source of emission of specific toxic particles and gases. We highlighted dioxins, whose representatives have been considered carcinogenic agents since 1994. Several experimental and epidemiologic studies have shown greater cancer morbidity and mortality associated with dioxin exposure. In the present study, we presented the impact of a hospital waste management program implemented in an oncology institution based on proper segregation and consequent reduction of incinerated mass. Data were collected for 8 years and the waste was separated into five categories: infectious (A4), chemical (B), recyclable (DR), non-recyclable (DNR), and sharps (E). The classes addressed to incineration were A4, B, and E. A team education starting from the admission process and with a continued education program was essential for a successfully implemented program. We achieved a 66% saving of waste from incineration, equivalent to 76 tons, of which 71.9 tons corresponded to recyclable waste. If the waste separation protocol was not implemented, the biohazardous and chemical material would contaminate the rest of the residues, making incineration as a final destination mandatory for all the waste. This scenario would result in significantly more dioxins release and a 64% higher cost of waste management. This low-cost implementation measure was effective in the cost reduction of waste management and minimization of air release of human carcinogens.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

Coronavirus pandemic (COVID-19) and its natural environmental impacts

Coronavirus Disease 2019 (COVID-19) is the official name of a respiratory infectious disease caused by a new coronavirus that started first in Wuhan, China, and outspread worldwide with an unexpectedly fast speed. Flights have been canceled worldwide and transportation has been closed nationwide and across international borders. As a consequence, the economic activity has been stopped and stock markets have been dropped. The COVID-19 lockdown has several social and economic effects. Additionally, COVID-19 has caused several impacts on global migration. On the other hand, such lockdown, along with minimal human mobility, has impacted the natural environment somewhat positively. Overall carbon emissions have dropped, and the COVID-19 lockdown has led to an improvement in air quality and a reduction in water pollution in many cities around the globe. A summary of the existing reports of the environmental impacts of COVID-19 pandemic are discussed and the important findings are presented focusing on several aspects: air pollution, waste management, air quality improvements, waste fires, wildlife, global migration, and sustainability.

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.