Environmental and economic assessments of industry-level medical waste disposal technologies - A case study of ten Chinese megacities

Medical waste (MW) is exploding due to the COVID-19 pandemic, posing a significant environmental threat, and leading to the urgent requirement for affordable and environmentally friendly MW disposal technologies. Prior research on individual MW disposal plants is region-specific, applying these results to other regions may introduce bias. In this study, major MW disposal technologies in China, i.e., incineration technologies (pyrolysis incineration and rotary kiln incineration), and sterilization technologies (steam sterilization, microwave sterilization, and chemical disinfection) with residue landfill or incineration were analyzed from an industry-level perspective via life cycle assessment (LCA), life cycle costing (LCC) and net present value (NPV) methods. Life cycle inventories and economic cost data for 4-5 typical companies were selected from 128 distinct enterprises and academic sources for each technology. LCA results show that microwave sterilization with residue incineration has the lowest environmental impact, emitting only 480 kg CO2 eq. LCC and NPV analyses indicate that steam sterilization with landfilling is the most economical, yielding revenues of 1,210 CNY/t and breaking even in the first year. Conversely, pyrolysis and rotary kiln incineration break even between the 4th and 5th years. Greenhouse gas emissions from the MW disposal in ten cities with the largest MW production in 2020 increased by 7% over 2019 to 43,800 tons and other pollutants increased by 6% to 12%. Economically, Shanghai exhibits the highest cost-effectiveness, while Nanjing delivers the lowest. It can be observed that the adoption of optimal environmental technologies has resulted in a diminution of greenhouse gas emissions by 279,000 tons and energy conservation of 1.76 billion MJ.

Research on transportation management model of COVID-19 medical waste: a case study in Beijing, China

During the COVID-19 pandemic, disposable masks, protective clothing, gloves, and nasopharyngeal swabs collected by nucleic acid testing formed a large amount of medical waste. Medical waste has strict temporary storage time requirements in hospitals, which need to be transported to medical waste disposal plants within the specified time. However, as most of disposal plants are far away from downtown, they also need to be responsible for the transportation and disposal of medical waste in many hospitals, and put forward higher requirement for transportation routes. Rapid and safe disposal of all types of medical waste generated by COVID-19 is crucial to the prevention and control of the epidemic. This paper designs the transportation route optimization model using Anylogic simulation software based on the regional distribution of 118 tertiary hospitals and 2 large medical waste disposal plants in Beijing, China. At the same time, transportation routes of 118 tertiary hospitals in the morning peak, evening peak, all-day, and ordinary periods were simulated based on the Beijing traffic index in 2017. On this basis, through the analysis of the simulation data, the selection of medical waste transport routes for 118 tertiary hospitals in the morning peak, evening peak, all day, and ordinary periods is further clarified, so as to ensure that medical waste can be transported to the medical waste disposal plant in the shortest time. The shortest path and fastest speed transport mode, medical waste transport data set, and the selection of transport mode of 118 tertiary hospitals formed by this research provide certain reference experience for the rapid and safe transport of medical waste during the epidemic period, and also provides corresponding data support for medical waste transportation management in the post-epidemic era and medical waste transportation decision-making when facing major public health problems.

Reusable laryngoscope blades: a more eco-responsible and cost-effective alternative

INTRODUCTION

Consumption of single-use medical devices has increased considerably, contributing to the excessive wastage produced during surgical procedures. The present study aimed to describe a methodology to assess the transition from single-use blades (SUB) to reusable laryngoscope blades (RUB) and to assess the ecological and economic impact of the switch.

METHODS

The ecological analysis was based on the life cycle assessment method. Based on 30 operating rooms in a single tertiary university hospital, the economic analysis compared the usual SUB supplier with four RUB suppliers considering different costs: blade purchasing and depreciation, reprocessing, logistics and waste management.

RESULTS

In 2021, 17,200 intubations were performed requiring about 147 RUBs. Switching from SUB to RUB led to an annual saving of 26.5 tons of CO2eq (global warming impact), equivalent to 120 000 km by car. It avoids the extraction of 6.6 tons Oileq (petroleum) and 579 kg of copper (mineral resources) per year. This action also leads to a land occupation reduction of 626 m2 per year and water savings of 221.6 m3 per year. The average cost per intubation varies from 3.16 [3.15-3.16] for SUB to 2.81 [2.77-2.85] for RUB, representing an average saving of 0.35 per intubation leading to 5783.50 annual gain [5074.00-6192.00]. RUB are preferable from 3 and 86 uses from an ecological and economic viewpoint, respectively.

CONCLUSION

In a model of 17,200 intubations /year, switching SUD to RUB would save 26.5 tons of CO2eq and 6.6 tons of Oileq with 5783.50 annual gain. RUBs are ecologically and cost-effective after 3 and 86 uses, respectively.

Assessing the impact of COVID-19 on waste generation: Focus on plastic, food, and medical wastes in South Korea

The COVID-19 pandemic may have considerably increased household and medical waste generation. However, waste generation patterns are not consistent and may vary globally. Therefore, using data (2018-2021) from 25 autonomous local governments under the Seoul Metropolitan Government, this study investigated whether plastic, food, and medical waste generation increased in South Korea during the pandemic. Descriptive statistics, spatial distribution patterns, and cluster analyses were used to examine the impact of COVID-19 on the jurisdictions. Results revealed that the fluctuations in plastic, food, and medical wastes generation had little impact on the waste management system in Seoul. Patterns varied little compared to the pre-COVID-19 period. This study raises the possibility that, while it may appear that there were waste management issues and waste accumulation during COVID-19, there is much variation in the results at the jurisdictional level. This showed that not all regions experienced problems in waste management during the pandemic.

Co-pyrolysis of medical protective clothing and oil palm wastes for biofuel: Experimental, techno-economic, and environmental analyses

The ongoing global pandemic of COVID-19 has devastatingly influenced the environment, society, and economy around the world. Numerous medical resources are used to inhibit the infectious transmission of the virus, resulting in massive medical waste. This study proposes a sustainable and environment-friendly method to convert hazardous medical waste into valuable fuel products through pyrolysis. Medical protective clothing (MPC), a typical medical waste from COVID-19, was utilized for co-pyrolysis with oil palm wastes (OPWs). The utilization of MPC improved the bio-oil properties in OPWs pyrolysis. The addition of catalysts further ameliorated the bio-oil quality. HZSM-5 was more effective in producing hydrocarbons in bio-oil, and the relevant reaction pathway was proposed. Meanwhile, a project was simulated to co-produce bio-oil and electricity from the co-pyrolysis of OPWs and MPC from application perspectives. The techno-economic analysis indicated that the project was economically feasible, and the payback period was 6.30-8.75 years. Moreover, it was also environmentally benign as its global warming potential varied from -211.13 to -90.76 kg CO₂-eq/t. Therefore, converting MPC and OPWs into biofuel and electricity through co-pyrolysis is a green, economic, and sustainable method that can decrease waste, produce valuable fuel products, and achieve remarkable economic and environmental benefits.

A review of the applicability of Environmental Management Systems in waste management in the medical sector of Zimbabwe

Environmental Management Systems (EMS) are currently the cornerstone of achieving sustainability globally. Nevertheless, the question is applicability of EMS in the medical sector. Hence, the review focused on applicability of EMS in medical waste management Zimbabwe. EMS involves overall processes that facilitate reduction of dire impacts of company's activities while increasing performance. EMS framework consists of environmental policy, planning, implementation, checking, review and improvement stages. To examine applicability of EMS in management of medical sector waste, published secondary sources with information related to the topic were utilised. Analysis of strengths and opportunities of EMS was used as a base to examine its applicability in medical waste management. Zimbabwean medical sector consist of hospitals and primary healthcare facilities. Medical waste includes pathological, pharmaceutical, cytotoxic, radioactive, chemical, sharp, infectious and general waste. However, twenty-first century witnessed expansion of medical institutions to accommodate COVID-19 patients, resulting in generation of construction and demotion waste. Medical institutions in Zimbabwe are accountable for solid waste management at generation source although municipalities are responsible for conveying solid waste to landfills. Solid waste from medical sector is disposed through traditional strategies namely landfilling, incineration, open pits and open burning, resulting in water, air, and soil contamination. However, EMS can reduce quantity of solid waste disposed through waste reuse, recycle and recovery. Moreover, achievement of integrated approach, effective legislation, policies and inclusive participation in medical waste management is adopted through use of EMS. Therefore, EMS were utilised to develop an integrated sustainable medical waste management model to achieve sustainability.

Conversion of medical waste into value-added products using a novel integrated system with tail gas treatment: Process design, optimization, and thermodynamic analysis

The COVID-19 pandemic has generated substantial medical waste (MW), posing risks to society. Based on widespread MW incineration, this study proposes an integrated system with tail gas treatment to convert MW into value-added products with nearly zero emissions. Herein, steam generators and supercritical CO₂ cycles were used to recover energy from MW to produce high-temperature/pressure steam and electricity. A simple power generation cycle achieved a net electricity efficiency of 22.4% through optimization. Thermodynamic analysis revealed that the most energy and exergy loss occurred in incineration. Furthermore, a pressurized reactive distillation column purified the resultant tail gas. The effects of inlet temperature, pressure, liquid/gas ratio, and recycle ratio on the removal and conversion efficiencies of NO₂ and SO₂ were evaluated. Nearly 100% of the SO₂ and 75% of the NO₂ generated by the incineration of MW have been converted into their acid forms. Based on the proposed tail gas treatment unit, high-purity CO₂ (∼98% purity) was finally obtained.

Healthcare waste in Bangladesh: Current status, the impact of Covid-19 and sustainable management with life cycle and circular economy framework

COVID-19 has accelerated the generation of healthcare (medical) waste throughout the world. Developing countries are the most affected by this hazardous and toxic medical waste due to poor management systems. In recent years, Bangladesh has experienced increasing medical waste generation with estimated growth of 3 % per year. The existing healthcare waste management in Bangladesh is far behind the sustainable waste management concept. To achieve an effective waste management structure, Bangladesh has to implement life cycle assessment (LCA) and circular economy (CE) concepts in this area. However, inadequate data and insufficient research in this field are the primary barriers to the establishment of an efficient medical waste management systen in Bangladesh. This study is introduced as a guidebook containing a comprehensive overview of the medical waste generation scenario, management techniques, Covid-19 impact from treatment to testing and vaccination, and the circular economy concept for sustainable waste management in Bangladesh. The estimated generation of medical waste in Bangladesh without considering the surge due to Covid-19 and other unusual medical emergencies would be approximately 50,000 tons (1.25 kg/bed/day) in 2025, out of which 12,435 tons were predicted to be hazardous waste. However, our calculation estimated that a total of 82,553, 168.4, and 2300 tons of medical waste was generated only from handling of Covid patients, test kits, and vaccination from March 2021 to May 2022. Applicability of existing guidelines, and legislation to handle the current situation and feasibility of LCA on medical waste management system to minimize environmental impact were scrutinized. Incineration with energy recovery and microwave sterilization were found to be the best treatment techniques with minimal environmental impact. A circular economy model with the concept of waste minimizaton, and value recovery was proposed for sustainable medical waste management. This study suggests proper training on healthcare waste management, proposing strict regulations, structured research allocation, and implementation of public-private partnerships to reduce, and control medical waste generation for creating a sustainable medical waste management system in Bangladesh.

Quantitative analysis of healthcare waste generation and composition in Antalya, Turkey

Health-care waste (HCW) may pose a risk to human health and the environment because of its infectious and/or toxic properties. This study was conducted to evaluate the quantity and composition of all the HCW generated by different producers in Antalya, Turkey, using data obtained from two online systems. Accordingly, this study explored the trends in healthcare waste generation (HCWG) between 2010 and 2020 and the impact of COVID-19 on HCWG by comparing the post- and pre-COVID-19 patterns based on the data obtained from 2,029 different producers. The collected data were based on the waste codes reported by the European Commission, were characterised based on the definition of the World Health Organization, and were further analysed according to the healthcare types defined by the Turkish Ministry of Health to characterize HCW. The findings indicate that the main HCW contributor was infectious waste (94.62 %), most of which was generated by hospitals (80 %). This is due to the inclusion of only HCW fractions in this study and to the definition of infectious waste considered. This study indicates that the categorisation into the type of HCSs may be a good option to assess the increase of HCW quantities, in accordance with the service type, size, and the effects of COVID-19. The correlation results for hospitals offering primary HCS revealed a strong relationship between the HCWG rate and the population per year. This approach may help estimate future trends to promote better HCW management practices for the specific cases considered, and it can even be applied to other cities.

An atmospheric microwave plasma-based distributed system for medical waste treatment

Inadequate handling of infectious medical waste may promote the spread of the virus through secondary transmission during the transfer process. Microwave plasma, an ease-of-use, device-compact, and pollution-free technology, enables the on-site disposal of medical waste, thereby preventing secondary transmission. We developed atmospheric-pressure air-based microwave plasma torches with lengths exceeding 30 cm to rapidly treat various medical wastes in situ with nonhazardous exhaust gas. The gas compositions and temperatures throughout the medical waste treatment process were monitored by gas analyzers and thermocouples in real time. The main organic elements in medical waste and their residues were analyzed by an organic elemental analyzer. The results showed that (i) the weight reduction ratio of medical waste achieved a maximum value of 94%; (ii) a water-waste ratio of 30% was beneficial for enhancing the microwave plasma treatment effect for medical wastes; and (iii) substantial treatment effectiveness was achievable under a high feeding temperature (≥ 600 °C) and a high gas flow rate (≥ 40 L/min). Based on these results, we built a miniaturized and distributed pilot prototype for microwave plasma torch-based on-site medical waste treatment. This innovation could fill the gap in the field of small-scale medical waste treatment facilities and alleviate the existing issue of handling medical waste on-site.

Investigation of gauze and medical bottle co-pyrolysis on the product formation, reactivity, and reaction pathway of char, liquid oil, and gas

Effective in-site treatment of medical waste has become a weak link in hospitals. Pyrolysis technology is a treatment method for medical waste that can enable rapid disposal in hospital settings and relieve environmental pressure, while also producing high-value products and reducing disposal costs. In this work, the effects of feedstock ratio and temperature on product yield and components of gauze (GA) and medical bottles (MB) co-pyrolysis have been investigated. The higher yield of solid products was obtained by co-pyrolysis of GA and MB at 400 ℃. With the addition of MB and an increase in temperature for the co-pyrolysis of GA and MB in a similar ratio, the pyrolysis oil and gas yields gradually increased. According to GC-MS analysis, co-feeding 75% MB to GA improved the alcohol content from 33.21% to a maximum yield of 59.8% at a pyrolysis temperature of 700 ℃. The content of aliphatic hydrocarbon reached 38.68% when the pyrolysis temperature and MB addition ratio were 700 °C and 75%, respectively. The GC data shows that the main gas components of co-pyrolysis of GA/MB were CH4 and H2, while the pyrolysis of pure GA or MB resulted in CO or CO2. Additionally, the solid carbon products obtained have an excellent pore structure. This strategy can benefit medical waste control and resource utilization for the low-cost disposal of medical waste and the acquisition of high-value resource products.

Graphical Abstract

Review on distribution, fate, and management of potentially toxic elements in incinerated medical wastes

Medical wastes include all solid and liquid wastes that are produced during the treatment, diagnosis, and immunisation of animals and humans. A significant proportion of medical waste is infectious, hazardous, radioactive, and contains potentially toxic elements (PTEs) (i.e., heavy metal (loids)). PTEs, including arsenic (As), cadmium (Cd), lead (Pb) and mercury (Hg), are mostly present in plastic, syringes, rubber, adhesive plaster, battery wastes of medical facilities in elemental form, as well as oxides, chlorides, and sulfates. Incineration and sterilisation are the most common technologies adopted for the safe management and disposal of medical wastes, which are primarily aimed at eliminating deadly pathogens. The ash materials derived from the incineration of hazardous medical wastes are generally disposed of in landfills after the solidification/stabilisation (S/S) process. In contrast, the ash materials derived from nonhazardous wastes are applied to the soil as a source of nutrients and soil amendment. The release of PTEs from medical waste ash material from landfill sites and soil application can result in ecotoxicity. The present study is a review paper that aims to critically review the dynamisms of PTEs in various environmental media after medical waste disposal, the environmental and health implications of their poor management, and the common misconceptions regarding medical waste.

Pyrolysis behavior, kinetics, and thermodynamics of waste pharmaceutical blisters under CO2 atmosphere

The disastrous impact of COVID-19 pandemic has caused a significantly increased production and use of pharmaceutical drugs, which is accompanied by the rapid generation of waste pharmaceutical blisters (WPBs). Nonetheless, its treatment has not gained appropriate attentions and a perceptible process development was not achieved. In this study, the WPBs pyrolysis in CO₂ atmosphere was conducted as well as the thermodynamics and kinetics were investigated. The thermogravimetric analysis revealed that the WPBs decomposition could be divided into two stages of 25 - 365 °C and 365 - 900 °C with mass loss of 56.5 - 60.5 wt% and 22.5 - 25.9 wt%, respectively. Fourier-transform infrared spectroscopy analysis indicated the dechlorination process initiating at ∼300 °C. The simultaneous asymmetric stretching of HCl and stretching vibration of C-Cl bond was detected in the range of 2600 - 3250 cm^-1 and 660 - 750 cm^-1, respectively. The dechlorination reactions were almost complete at ∼520 °C and minor peaks (2900 -3100 cm^-1) due to C-H vibrations were observed. Gas chromatography-mass spectrometry analysis indicated that the evolved products included alkanes, benzene, olefin, as well as HCl. The cycloalkenes content significantly increased during the second conversion stage, implying the addition reactions between alkanes and olefins. The apparent activation energy was calculated using three model-free methods and the values from Flynn-Wall-Ozawa model increased from 142.0 to 255.8 kJ·mol^-1 with an average value of 147.4 kJ·mol^-1. The methods of Coats-Redfern as well as Malek were applied to determine the reaction mechanism. The one-dimensional diffusion model was more reliable to describe the WPBs pyrolysis. This study will represent a significant reference case for the thermochemical conversion of multilayer packing waste and facing the increasing demand for the medical waste recycling.

Capacity assessment to secure COVID-19 waste treatment in Vietnam

The accelerated generation of COVID-19 waste under the Delta-fuelled outbreak placed a sudden burden on waste disposal in Vietnam. To secure the treatment of COVID-19 waste amid the pandemic uncertainty, treatment capacity was assessed by determining treatment occupancy rate-the ratio of estimated demand to calculated capacity-both nationally and in Ho Chi Minh City. At the general occupancy rate for COVID-19 waste treatment of 7.4%, the country was capable of handling COVID-19 waste, with a capacity to treat 62 191 t month^-1. However, Ho Chi Minh City became overwhelmed, indicated by a treatment occupancy rate of up to 780% during the Delta outbreak, as the unanticipated growth of demand for COVID-19 waste treatment caused waste to back up. The assessment results, in addition to current legislation, support collaboration in waste treatment as a solution to using existing resources to address the acute shortage of treatment capacity, so as to secure COVID-19 waste treatment. The findings could be used by other developing countries to tackle the waste problem in the pandemic era.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10163-022-01529-z.

A Comparative Analysis of Hazardous Medical Waste Management Compliance Before (2019) and During (2020) the COVID-19 Pandemic in Indonesia

BACKGROUND

As a producer of hazardous waste, hospitals have the responsibility to manage the waste they produce. Hospital non-compliance in managing hazardous waste can have a negative impact on the environment and public health, especially during the COVID-19 pandemic, when the amount of hazardous waste produced by healthcare facilities is increasing. To protect the environment and public health from the negative impact of hazardous medical waste, this study was conducted to determine the level of compliance of hazardous waste management in hospitals in Indonesia before and during the COVID-19 pandemic, from 2019 to 2020.

STUDY DESIGN

Cross-sectional.

METHODS

This study was conducted at 343 hospitals in Indonesia using secondary data obtained from Sikelim (Medical Waste Management Information System), which is owned and operated by the Ministry of Health. The data have been analyzed using chi-square tests and logistic regressions of the determinant model.

RESULTS

There was an increase in the level of compliance of hazardous waste management in hospitals from 82% to 86% during the pandemic. Furthermore, the availability of environmental documents and environmental health units were determinant factors of hazardous waste management compliance by hospitals before the pandemic in 2019. The only factor in 2020 was the availability of environmental health units.

CONCLUSIONS

Despite the good level of compliance, additional efforts are needed to increase the activities of the treatment of hazardous medical waste by hospitals, as before the pandemic (i.e., in a normal situation) only 8% of hospitals was able to independently manage hazardous medical waste using authorized incinerators, a percentage that was reduced to 6% during the pandemic.

Analysis of COVID-19 waste management in Vietnam and recommendations to adapt to the 'new normal' period

Amid the 4th wave of COVID-19, Vietnam reopened its economy, which placed extra burdens on the COVID-19 waste management system. This study analyzed existing issues and recommended adaptations to secure appropriate management of COVID-19 waste under the 'new normal' pandemic period. Results showed changes in COVID-19 waste characteristics (e.g., rapid rise in waste generation, lower percentage of plastic) and multiple other issues (e.g., presence of COVID-19 waste in municipal waste, lack of temporary storage sites and local treatment capacity), along with greater waste-handling responsibilities placed on authorities and higher infection risks. To adapt to the 'new normal', introduction of separate handling routes and collaboration in waste treatment were recommended. Employing the network of pharmacies used for vaccination would require COVID-19 waste collection from scattered, small-scale sources as part of the waste management solution. Also, following the 4R initiatives (reduce, reuse, recycle, recovery) could help ease the burden on the country's waste system and provide additional opportunities to move towards a circular economy in the post-acute COVID-19 era. The findings should contribute to a safer co-existence with the virus through appropriate waste management in Vietnam and could be used to tackle waste problems in other developing countries.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10163-022-01563-x.

Recent advances and challenges in recycling and reusing biomedical materials

Medical waste has increased in the past 3 years as a result of the coronavirus disease 2019 (COVID-19) pandemic. This condition is expected to exacerbate due to the growing healthcare markets and aging population, posing health threats to the public via environmental footprints. To alleviate these impacts, there is an urgent need for medical waste management. This article highlights the drawbacks of current disposal methods and the potential of medical waste reuse and recycling, emphasizing the processes, materials, and chemistry involved in each practice. Further discussion is provided on the chemical and mechanical recycling of plastics as the dominating material in biomedical applications, and possible strategies and challenges in recycling and reusing biomedical materials are explored in this review.

Adsorption performance and mechanism of cationic and anionic dyes by KOH activated biochar derived from medical waste pyrolysis

The massive generation of medical waste (MW) results in a series of environmental, social, and ecological problems. Pyrolysis is one such approach that has attracted more attention because of the production of value-added products with lesser environmental risk. In this study, the activated biochar (ABC600) was obtained from MW pyrolysis and activated with KOH. The adsorption mechanism of activated biochar on cationic (methylene blue) and anionic (reactive yellow) dyes were studied. The physicochemical characterization of biochar showed that increasing pyrolysis temperature and KOH activation resulted in increased surface area, a rough surface with a clear porous structure, and sufficient functional groups. MB and RYD-145 adsorption on ABC600 was more consistent with Langmuir isotherm (R² ≥ 0.996) and pseudo-second-order kinetics (R² ≥ 0.998), indicating chemisorption with monolayer characteristics. The Langmuir model fitting demonstrated that MB and RYD-145 had maximum uptake capacities of 922.2 and 343.4 mg⋅g^-1. The thermodynamics study of both dyes showed a positive change in enthalpy (ΔH°) and entropy (ΔS°), revealing the endothermic adsorption behavior and randomness in dye molecule arrangement on activated-biochar/solution surface. The activated biochar has excellent adsorption potential for cationic and anionic dyes; hence, it can be considered an economical and efficient adsorbent.

Quantifying the spatiotemporal evolution characteristics of medical waste generation during the outbreak of public health emergencies

Based on the medical waste quantity and patient data during the corona virus disease 2019 (COVID-19) outbreak in China, this study used scenario analysis to quantitatively analyze the temporal and spatial evolution of medical waste generation during the pandemics. First, the results show that the estimated medical waste per capita reached 15.4 kg/day if only patients were considered in Scenario 1, while the figures were reduced to 3.2 kg/day in Scenario 2 and 2.5 kg/day in Scenario 3 when the effects of both the patient type and the number of medical staffs were considered. The estimated results also demonstrated that the per capita medical waste related to the epidemic showed the characteristics of a U-shaped and trailing phenomenon over time. Then, the amount of medical waste related to the COVID-19 generated that generated due to COVID-19 was estimated in Hubei, Heilongjiang, Zhejiang, Henan and Hunan provinces under Scenario 2 and Scenario 3. The results indicated that the spatiotemporal evolution characteristics of five provinces show the significant differences, and the patient type has a remarkable influence on the generation of medical waste. Finally, a novel decomposition-ensemble approach was designed to make a better short-term forecasting effect for future medical waste generation in different provinces.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10163-022-01523-5.

To what extent do waste management strategies need adaptation to post-COVID-19?

The world has been grappling with the crisis of the COVID-19 pandemic for more than a year. Various sectors have been affected by COVID-19 and its consequences. The waste management system is one of the sectors affected by such unpredictable pandemics. The experience of COVID-19 proved that adaptability to such pandemics and the post-pandemic era had become a necessity in waste management systems and this requires an accurate understanding of the challenges that have been arising. The accurate information and data from most countries severely affected by the pandemic are not still available to identify the key challenges during and post-COVID-19. The documented evidence from literature has been collected, and the attempt has been made to summarize the rising challenges and the lessons learned. This review covers all raised challenges concerning the various aspects of the waste management system from generation to final disposal (i.e., generation, storage, collection, transportation, processing, and burial of waste). The necessities and opportunities are recognized for increasing flexibility and adaptability in waste management systems. The four basic pillars are enumerated to adapt the waste management system to the COVID-19 pandemic and post-COVID-19 conditions. Striving to support and implement a circular economy is one of its basic strategies.

Elucidating the role of environmental management of forests, air quality, solid waste and wastewater on the dissemination of SARS-CoV-2

The increasing frequency of zoonotic diseases is amongst several catastrophic repercussions of inadequate environmental management. Emergence, prevalence, and lethality of zoonotic diseases is intrinsically linked to environmental management which are currently at a destructive level globally. The effects of these links are complicated and interdependent, creating an urgent need of elucidating the role of environmental mismanagement to improve our resilience to future pandemics. This review focused on the pertinent role of forests, outdoor air, indoor air, solid waste and wastewater management in COVID-19 dissemination to analyze the opportunities prevailing to control infectious diseases considering relevant data from previous disease outbreaks. Global forest management is currently detrimental and hotspots of forest fragmentation have demonstrated to result in zoonotic disease emergences. Deforestation is reported to increase susceptibility to COVID-19 due to wildfire induced pollution and loss of forest ecosystem services. Detection of SARS-CoV-2 like viruses in multiple animal species also point to the impacts of biodiversity loss and forest fragmentation in relation to COVID-19. Available literature on air quality and COVID-19 have provided insights into the potential of air pollutants acting as plausible virus carrier and aggravating immune responses and expression of ACE2 receptors. SARS-CoV-2 is detected in outdoor air, indoor air, solid waste, wastewater and shown to prevail on solid surfaces and aerosols for prolonged hours. Furthermore, lack of protection measures and safe disposal options in waste management are evoking concerns especially in underdeveloped countries due to high infectivity of SARS-CoV-2. Inadequate legal framework and non-adherence to environmental regulations were observed to aggravate the postulated risks and vulnerability to future waves of pandemics. Our understanding underlines the urgent need to reinforce the fragile status of global environmental management systems through the development of strict legislative frameworks and enforcement by providing institutional, financial and technical supports.

Sentinel lymph node mapping for endometrial cancer: Opportunity for medical waste reform

OBJECTIVE

As healthcare expenditures continue to rise, identifying mechanisms to reduce unnecessary costs is critical. The objective of this study is to estimate the annual cost of wasted indocyanine green (ICG) used for sentinel lymph node mapping in patients with endometrial cancer.

METHODS

Using the Surveillance, Epidemiology, and End Results program database and Premier database, we determined the annual number of cases in which sentinel lymph node mapping with ICG would be used and the median cost of ICG to institutions and patients, respectively. We assumed that gynecologic oncologists use 2-4 mL (20-40%) of the currently available ICG vial kit (25 mg per 10 mL) per case. Estimated waste was then calculated using cost as a measure of institutional waste and charge as excess cost transferred to patients or payers.

RESULTS

An estimated 45,864 cases of localized endometrial cancer were identified and eligible for sentinel lymph node (SLN) mapping. The mean total cost associated with ICG was 99.20 and the mean charge was $483.64. The estimated excess annual cost to hospitals was $2,729,825 to $3,639,767. Similarly, using mean charge data, the annual cost of wasted drug for patients and payers was $13,308,999 to $17,745,332.

CONCLUSIONS

The annual cost of wasted ICG due to its current manufactured vial size exceeds $2 million for hospitals and $13.3-$17.7 million for patients. We suggest ICG vials should be packaged in a 10 mg vial kit (2-4 mL sterile solution) to avoid drug waste and the financial impact to institutions and patients.

Principal of environmental life cycle assessment for medical waste during COVID-19 outbreak to support sustainable development goals

Disposal of medical waste (MW) must be considered as a vital need to prevent the spread of pandemics during Coronavirus disease of the pandemic in 2019 (COVID-19) outbreak in the globe. In addition, many concerns have been raised due to the significant increase in the generation of MW in recent years. A structured evaluation is required as a framework for the quantifying of potential environmental impacts of the disposal of MW which ultimately leads to the realization of sustainable development goals (SDG). Life cycle assessment (LCA) is considered as a practical approach to examine environmental impacts of any potential processes during all stages of a product's life, including material mining, manufacturing, and delivery. As a result, LCA is known as a suitable method for evaluating environmental impacts for the disposal of MW. In this research, existing scenarios for MW with a unique approach to emergency scenarios for the management of COVID-19 medical waste (CMW) are investigated. In the next step, LCA and its stages are defined comprehensively with the CMW management approach. Moreover, ReCiPe2016 is the most up-to-date method for computing environmental damages in LCA. Then the application of this method for defined scenarios of CMW is examined, and interpretation of results is explained regarding some examples. In the last step, the process of selecting the best environmental-friendly scenario is illustrated by applying weighting analysis. Finally, it can be concluded that LCA can be considered as an effective method to evaluate the environmental burden of CMW management scenarios in present critical conditions of the world to support SDG.

The impact of COVID-19 pandemic in medical waste amounts: a case study from a high-populated city of Turkey

In this study, the amount of medical waste generated in a high-populated city in Turkey between January 2018 and August 2021 was evaluated, and the effect of the COVID-19 pandemic on waste amounts and waste production rate was investigated. While a total of 79,027 kg/month of medical waste was produced in the city before COVID-19, this value reached 116,714 kg/month after COVID-19. The increase in the amount of medical waste due to the COVID-19 pandemic in the province was calculated as 48% on average. It was determined that 75% of this waste amount originates from public hospitals in the city. While the production of medical waste was 0.86 kg/bed day in the pre-COVID-19 period, this value increased to 0.96 kg/bed day in 2020 and to 1.34 kg/bed day in 2021 with the COVID-19 pandemic. According to the results obtained, the amount of medical waste reached in the province due to COVID-19 is the amount of medical waste expected to be generated in the 2040s under normal conditions. It is a very important issue in terms of public health that the capacity of waste disposal in medical waste management in cities is flexible to respond to severe epidemic conditions. Based on the information obtained within the scope of the study, changes in the amount of medical waste in a city with a dense population under pandemic conditions can be obtained based on real data and projections regarding disposal capacity can be made more realistically.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s10163-022-01428-3.

A review on emergency disposal and management of medical waste during the COVID-19 pandemic in China

The surge of medical waste (MW) generated during the COVID-19 pandemic has exceeded the disposal capacity of existing facilities. The timely, safe, and efficient emergency disposal of MW is critical to prevent the epidemic spread. Therefore, this review presents the current status of MW generation and disposal in China and analyzes the characteristics and applicability of emergency disposal technologies. The results show that movable disposal facilities can dispose of infectious MW on site, even though most of their disposal capacity is at a low level (<5 t/day). Co-disposal facilities need to be reformed completely for emergency MW disposal, in which separate feeding systems should be taken seriously. Specifically, municipal solid waste (MSW) incineration facilities have great potential to improve emergency MW disposal capacities. For hazardous waste incineration facilities, compatibility of the wastes must be matched to the composition and calorific value of the waste. As for cement kiln, MW can only be used as an alternative fuel instead of a raw material for cement. Based on the environmental risk and technical adaptability, the six emergency MW disposal technologies are recommended to be prioritized as follows: movable microwave sterilization, movable steam sterilization, movable incineration, co-incineration with hazardous waste, co-incineration with MSW and co-disposal in cement kilns. Infectious MW, especially COVID-19 MW, should be prioritized for disposal by centralized and movable disposal facilities, while non-infectious MW can be disposed of using co-disposal facilities. All stakeholders should strengthen the delicacy management of the end-of-life stage of MW, including collection, classification, packaging identification, transportation, and disposal. Currently, it is necessary for centralized disposal enterprises to follow the emergency disposal operation flowchart. From a long-term strategic perspective, making full use of regional movable and co-disposal facilities in the megacities can effectively enhance the emergency MW disposal capacity.

Mapping healthcare waste management research: Past evolution, current challenges, and future perspectives towards a circular economy transition

Improper healthcare waste (HCW) management poses significant risks to the environment, human health, and socio-economic sustainability due to the infectious and hazardous nature of HCW. This research aims at rendering a comprehensive landscape of the body of research on HCW management by (i) mapping the scientific development of HCW research, (ii) identifying the prominent HCW research themes and trends, and (iii) providing a research agenda for HCW management towards a circular economy (CE) transition and sustainable environment. The analysis revealed four dominant HCW research themes: (1) HCW minimization, sustainable management, and policy-making; (2) HCW incineration and its associated environmental impacts; (3) hazardous HCW management practices; and (4) HCW handling and occupational safety and training. The results showed that the healthcare industry, despite its potential to contribute to the CE transition, has been overlooked in the CE discourse due to the single-use mindset of the healthcare industry in the wake of the infectious, toxic, and hazardous nature of HCW streams. The findings shed light on the HCW management domain by uncovering the current status of HCW research, highlighting the existing gaps and challenges, and providing potential avenues for further research towards a CE transition in the healthcare industry and HCW management.

Energy, environment and economy assessment of medical waste disposal technologies in China

Medical waste (MW) has exploded since the COVID-19 pandemic and aroused great concern to MW disposal. Meanwhile, the energy recovery for MW disposal is necessary due to high heat value of MW. Harmless disposal of MW with economically and environmentally sustainable technologies along with higher energy recovery is urgently required, and their energy recovery efficiencies and environmental impacts reduction due to energy recovery are key issues. In this study, five MW disposal technologies, i.e. rotary kiln incineration, pyrolysis incineration, plasma melting, steam sterilization and microwave sterilization, were evaluated and compared via energy recovery analysis (ERA), life cycle assessment (LCA), and life cycle costing (LCC) methods. Furthermore, three MW incineration technologies with further energy recovery and two sterilization followed by co-incineration technologies were analyzed to explore their improvement potential of energy recovery and environment benefits via scenario analysis. ERA results reveal that the energy recovery efficiencies of "steam and microwave sterilization + incineration" are the highest (≥83.4%), while that of the plasma melting is the lowest (19.2%). LCA results show that "microwave sterilization + landfill" outperforms others while the plasma melting exhibits the worst, electricity is the most significant contributor to the environmental impacts of five technologies. Scenario analysis shows that the overall environmental impact of all technologies reduced by at least 45% after further heat utilization. LCC results demonstrate that pyrolysis incineration delivers the lowest economic cost, while plasma melting is the highest. Co-incineration of sterilized MW and municipal solid waste could be recommended.

COVID-19, a double-edged sword for the environment: a review on the impacts of COVID-19 on the environment

This review paper discusses the most relevant impacts of the COVID-19 pandemic on the environment. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China, in December 2019. The disease has infected 70 million people and caused the death of 1.58 million people since the US Food and Drug Administration issued an Emergency Use Authorization to develop a vaccine to prevent COVID-19 on December 11, 2020. COVID-19 is a global crisis that has impacted everything directly connected with human beings, including the environment. This review discusses the impacts of COVID-19 on the environment during the pandemic and post-COVID-19 era. During the first months of the COVID pandemic, global coal, oil, gas, and electricity demands declined by 8%, 5%, 2%, and 20%, respectively, relative to 2019. Stay-at-home orders in countries increased the concentrations of particles in indoor environments while decreasing the concentrations of PM2.5 and NOX in outdoor environments. Remotely working in response to the COVID-19 pandemic increased the carbon, water, and land footprints of Internet usage. Microplastics are released into our environment from the mishandling and mismanagement of personal protective equipment that endanger our water, soils, and sediments. Since the COVID-19 vaccine cannot be stored for a long time and spoils rapidly, more awareness of the massive waste of unused doses is needed. So COVID-19 is a double-edged sword for the environment.

Medical waste management during coronavirus disease 2019 pandemic at the city level

Coronavirus disease 2019 brings about the economic damage and loss of life. Thus, demand of personal protective equipment continues to increase, consequently an increase in infectious equipment pollution. Most of these wastes threaten the environment and increase the spread of diseases. This paper provides a research hypothesis whether effective medical waste management would prevent the possible impacts of coronavirus disease 2019-related waste issues on environment at the city level. To confirm this hypothesis, installation of waste treatment centre is addressed. Then, by incorporating uncertain waste generation amounts utilizing Jimenez method, a pickup routing is addressed to decide the pickup routes between the waste treatment centre and residential area. This study is first to assign the optimistic, realistic and pessimistic scenarios of the uncertain waste generation using time series analysis method and waste generation formulation. Also, L-type matrix is used to define, assess and prioritize the environmental and operational risks on waste generation formulation and to provide risk reaction strategies. Practicality of these approaches is illustrated in the case of Turkey. The computational results reveal the effectiveness of the integrated method, which ensures practical and theoretical insights controlling the waste generation to prevent virus propagation for health authorities.

Evaluation and selection of healthcare waste incinerators using extended sustainability criteria and multi-criteria analysis methods

Disposal of healthcare waste is a key issue of environmental sustainability in the world. The amount of healthcare waste is increasing every day, and it is necessary to adequately dispose of this kind of waste. There are various treatments for healthcare waste disposal, of which incineration of healthcare waste is one of the solutions. This paper suggests a model for selection of the type of incinerators that best solve the problem of healthcare waste in secondary healthcare institutions in Bosnia and Herzegovina. In the selection of incinerators, extended sustainability criteria were applied. Basic sustainability criteria: environmental, economic, and social criteria, were extended with the technical criterion. To assess which of the incinerators best meets the needs for healthcare waste collection, multi-criteria decision-making was used. For this purpose, a combination of two MCDA methods was applied in this paper, namely full consistency method (FUCOM) and compromise ranking of alternatives from distance to ideal solution (CRADIS). The FUCOM method was applied to determine the weights of the criteria, while the CRADIS method was applied to rank the alternatives. The best alternative of the six alternatives used is A2 (I8-M50), followed by alternative A1 (I8-M40), while the worst ranked alternative is A5 (I8-M100). These results were confirmed by applying the other six methods of multi-criteria analysis and the performed sensitivity analysis. The contribution of this paper is reflected through a new method of multi-criteria analysis that was used to solve decision-making problems. This method has shown simplicity and flexibility in operation and can be used in all problems when it is necessary to make a multi-criteria selection of alternatives.

Redefining bio medical waste management during COVID- 19 in india: A way forward

India is ranked 120 among 165 nations with respect to sustainable development and critically suffers from insufficient waste treatment provisions and amenities. And the abrupt occurrence of the COVID-19 virus has aggravated the issue of managing of medical waste in India, manifolds. As a result, the safe disposal of a huge volume of hazardous medical waste has become a top priority. This conceptual study evaluates India's management of medical waste during the COVID-19 pandemic. Additionally, this article aims to highlight the inadequacies in India's implementation of the BMW 2016 standards by a synthesis of multiple agency reports (government and non-government) and data obtained directly from the Central Pollution Control Board (CPCB). The findings indicate that India is well behind in terms of COVID-19 waste management and requires comprehensive monitoring and implementation systems to enable the achievement of SDGs related to environmental health.

Plastic waste associated with the COVID-19 pandemic: Crisis or opportunity?

Coronavirus Diseases 2019 (COVID-19) pandemic has a huge impact on the plastic waste management in many countries due to the sudden surge of medical waste which has led to a global waste management crisis. Improper management of plastic waste may lead to various negative impacts on the environment, animals, and human health. However, adopting proper waste management and the right technologies, looking in a different perception of the current crisis would be an opportunity. About 40% of the plastic waste ended up in landfill, 25% incinerated, 16% recycled and the remaining 19% are leaked into the environment. The increase of plastic wastes and demand of plastic markets serve as a good economic indicator for investor and government initiative to invest in technologies that converts plastic waste into value-added product such as fuel and construction materials. This will close the loop of the life cycle of plastic waste by achieving a sustainable circular economy. This review paper will provide insight of the state of plastic waste before and during the COVID-19 pandemic. The treatment pathway of plastic waste such as sterilisation technology, incineration, and alternative technologies available in converting plastic waste into value-added product were reviewed.

Plasma gasification of the medical waste

In terms of infection control in hospitals, especially the Covid-19 pandemic that we are living in, it has revealed the necessity of proper disposal of medical waste. The increasing amount of medical waste with the pandemic is straining the capacity of incineration facilities or storage areas. Converting this waste to energy with gasification technologies instead of incineration is also important for sustainability. This study investigates the gasification characteristics of the medical waste in a novel updraft plasma gasifier with numerical simulations in the presence of the plasma reactions. Three different medical waste samples, chosen according to the carbon content and five different equivalence ratios (ER) ranging from 0.1 to 0.5 are considered in the simulations to compare the effects of different chemical compositions and waste feeding rates on hydrogen (H₂) content and syngas production. The outlet properties of a 10 kW microwave air plasma generator are used to define the plasma inlet in the numerical model and the air flow rate is held constant for all cases. Results showed that the maximum H₂ production can be obtained with ER = 0.1 for all waste samples.

Insights into hazardous solid waste generation during COVID-19 pandemic and sustainable management approaches for developing countries

The recent emergence of the COVID-19 pandemic has contributed to the drastic production and use of healthcare and personal protective equipment, leading to the release of a huge quantity of hazardous medical and solid wastes in the environment. Meanwhile, these solid wastes may contribute to the spread of the SARS-CoV-2 viral particles when disposed of without proper treatment and care. Since SARS-CoV-2 could persist on different material surfaces including plastic, steel, paper, cardboard, cloth, and wood, proper management of these hazardous solid wastes has become a challenging task during the COVID-19 pandemic. In this paper, an overview of the consumption of COVID-19-related healthcare and personal protective equipment along with the production of hazardous solid waste is presented. The efficient management of these wastes is necessary to prevent the entering of SARS-CoV-2 in various environmental compartments. Therefore, some preventive measures including the use of biodegradable materials for manufacturing personal protective equipment, minimizing the use of non-biodegradable materials, efficient pre- and-post planning, careful segregation, and disposal are, therefore, proposed for their sustainable management. The findings reported in this paper contribute to tackling the problems associated with hazardous solid waste management, particularly for low- and middle-income countries.

Investigation of potential safety hazards during medical waste disposal in SARS-CoV-2 testing laboratory

This study aims to investigate the potential safety hazards and provide reference for improving the medical waste disposal procedure in SARS-CoV-2 testing laboratory. Our SARS-CoV-2 testing group detected the RNA residue on the surface of medical waste with Droplet Digital PCR, and held a meeting to discuss the risks in the laboratory medical waste disposal process. After effective autoclaving, SARS-CoV-2 contaminated on the surface of medical waste bags was killed, but the average concentration of viral RNA residues was still 0.85 copies/cm². It would not pose a health risk, but might contaminate the laboratory and affect the test results. When the sterilized medical waste bags were transferred directly by the operators without hand disinfection, re-contamination would happen, which might cause the virus to leak out of the laboratory. Furthermore, we found that sterilization effect monitoring and cooperation among operators were also very important. In summary, we investigated and analyzed the potential safety hazards during the medical waste disposal process in SARS-CoV-2 testing laboratory, and provided reasonable suggestions to ensure the safety of medical waste disposal.

Safe distance-based vehicle routing problem: Medical waste collection case study in COVID-19 pandemic

In addition to the increasing population and rapid urbanization, the amount and variety of medical waste are rapidly increasing due to the coronavirus disease (COVID-19) pandemic affecting the whole world. COVID-19 does not only increase the amount of medical waste produced, medical wastes generated in the care of COVID-19 carries a high risk of transmission as well. In this regard, the safe and effective management of medical wastes has become a serious health and safety issue. This research aims to determine the safest and shortest transportation routes for medical waste vehicles. The safety scores used in this study were obtained in our previous study. The resulting safety scores were used in a multi-objective traveling salesman problem for deriving two objective functions, which are based on safety scores and total transportation distance. A conciliating solution was obtained by solving this linear programming model. The proposed model faced by health institutions in Istanbul has been applied for a specific district. According to the obtained results, suggestions for the direction of medical waste vehicles have been proposed.

What medical waste management system may cope With COVID-19 pandemic: Lessons from Wuhan

The global pandemic caused by the 2019 coronavirus (COVID-19) has led to a dramatic increase in medical waste worldwide. This tremendous increase in medical waste is an important transmission medium for the virus and thus poses new and serious challenges to urban medical waste management. This study investigates the response of medical waste management to the COVID-19 pandemic and subsequent changes in Wuhan City based on the most detailed data available, including waste generation, storage, transportation, and disposal. The results show that despite a 5-fold increase in the demand for daily medical waste disposal in the peak period, the quick responses in the storage, transportation, and disposal sectors during the pandemic ensured that all medical waste was disposed of within 24 hours of generation. Furthermore, this paper discusses medical waste management during future emergencies in Wuhan. The ability of the medical waste management system in Wuhan to successfully cope with the rapid increase in medical waste caused by major public health emergencies has important implications for other cities suffering from the pandemic and demonstrates the need to establish resilient medical emergency systems in urban areas.

Effect of COVID-19 pandemic on medical waste management: a case study

Covid-19 Pandemic leads to medical services for the society all over the world. The Covid-19 pandemic influence the waste management and specially medical waste management. In this study, the effect of the Covid-19 outbreak on medical waste was evaluated via assessing the solid waste generation, composition, and management status in five hospitals in Iran. The results indicated that the epidemic Covid-19 leads to increased waste generation on average 102.2 % in both private and public hospitals. In addition, the ratio of infectious waste in the studied hospitals increased by an average of 9 % in medical waste composition and 121 % compared with before COVID-19 pandemic. Changes in plans and management measurement such as increasing the frequency of waste collection per week leads to lower the risk of infection transmission from medical waste in the studied hospitals. The results obtained from the present research clearly show the changes in medical waste generation and waste composition within pandemic Covid-19. In addition, established new ward, Covid-19 ward with high-infected waste led to new challenges which should be managed properly by change in routine activities.

Municipal solid waste management during COVID-19 pandemic: effects and repercussions

The COVID-19 pandemic has an adverse effect on the environment. This epidemic's effect on the waste composition and management and the impacts of municipal solid waste management (MSWM) on disease transmission or controlling are considered a compelling experience of living in the COVID-19 pandemic that can effectively control the process. This systematic review research was conducted to determine the effects of COVID-19 on the quantity of waste and MSWM. Searches were conducted in three databases (using keywords covid 19, coronaviruses, and waste), and among the published articles from 2019 to 2021, 56 ones were selected containing information on the quantity and waste management during the COVID-19 pandemic. The results showed that COVID-19 caused the quantity variation and composition change of MSW. COVID-19 also has significant effects on waste recycling, medical waste management, quantity, and littered waste composition. On the other hand, the COVID-19 pandemic has changed waste compounds' management activities and waste generation sources. Recognizing these issues can help plan MSWM more efficiently and reduce virus transmission risk through waste.

Environmental challenges from the increasing medical waste since SARS outbreak

Medical waste is a special class of hazardous pollutants. Improper treatment would cause secondary environmental pollution, especially when responding to public health emergencies. However, there are relatively few researches on the generation of medical waste, and there is a lack of basic understanding of its spatial-temporal heterogeneity. The outbreak of SARS in 2002 is a turning point in China's medical system reform. We estimated the production of medical waste and pollutants on a provincial scale in China from 2002 to 2018, using the data of medical statistics. Moreover, we forecasted the trend of medical waste in China until 2030, using a combination of environmental pressure model (STIRPAT) and time series model (ARIMA). We found that with the development of China's medical system and economy (such as the increase in personal income and popularization of universal health care), the number of seeking medical treatment rapidly increase led to explosive growth in medical waste (∼240%) and pollutants (∼260%), and large hospitals are the major sources. By 2030, the production of medical waste would still increase by more than 50% compared with 2018 even there is no the pandemic due to the huge population. The production of medical waste in the eastern region was higher than that in the west under the influence of higher population and GDP, while the per capita medical waste was only affected by household consumption level which had no regional characteristic. Additionally, Hg loads from medical waste are more than twice as high as that from discharged wastewater in some regions, which are facing great control pressures. In the future, when planning for medical waste disposal, policymakers shall increase the disposal facilities based on population and promote mobile treatment equipment to improve efficiency, increase the number of beds in medical institutions rather than building more hospitals, and strengthen basic research on the environmental impact.

Technological review on thermochemical conversion of COVID-19-related medical wastes

COVID-19 pandemic has brought tremendous environmental burden due to huge amount of medical wastes (about 54,000 t/d as of November 22, 2020), including face mask, gloves, clothes, goggles, and sanitizer/disinfectant containers. A proper waste management is urgently required to mitigate the spread of the disease, minimize the environmental impacts, and take their potential advantages for further utilization. This work provides a prospective review on the possible thermochemical treatments for those COVID-19 related medical wastes (CMW), as well as their possible conversion to fuels. The characteristics of each waste are initially analyzed and described, especially their potential as energy source. It is clear that most of CMWs are dominated by plastic polymers. Thermochemical processes, including incineration, torrefaction, pyrolysis, and gasification, are reviewed in terms of applicability for CMW. In addition, the mechanical treatment of CMW into sanitized refuse-derived fuel (SRDF) is also discussed as the preliminary stage before thermochemical conversion. In terms of material flexibility, incineration is practically applicable for all types of CMW, although it has the highest potential to emit the largest amount of CO₂ and other harmful gasses. Furthermore, gasification and pyrolysis are considered promising in terms of energy conversion efficiency and environmental impacts. On the other hand, carbonization faces several technical problems following thermal degradation due to insufficient operating temperature.

Unprecedented plastic-made personal protective equipment (PPE) debris in river outlets into Jakarta Bay during COVID-19 pandemic

Increased plastic uses during COVID-19 pandemic challenges efforts to reduce marine plastic debris. Despite recent observations of increased plastic-made personal protection equipment (PPE) waste in coastal areas, comparative data before and during the pandemic lacked. We present in situ monitoring data on riverine debris releases into Jakarta Bay, Indonesia, during COVID-19 pandemic relative to the 2016 baseline data. River debris at two river outlets - the Cilincing and Marunda Rivers, revealed a 5% increase in the abundance of debris and a 23-28% decrease in the weight of debris releases in March-April 2020 compared to March-April 2016, suggesting a compositional shift towards lighter debris. Plastics continued to dominate river debris at 46% (abundance) or 57% (weight). Unique to the pandemic, we observed an unprecedented presence of PPE (medical masks, gloves, hazard suits, face shields, raincoats) that accounted for 15-16% of the collected river debris of 780 ± 138 items (abundance) or 0.13 ± 0.02 tons (weight) daily. The observed increased plastic-made PPE in river outlets urges for improved medical waste management of domestic sources during the prolonged pandemic.

Incineration experiment of medical waste of novel coronavirus pneumonia (COVID-19) in a mobile animal carcass incinerator

Incineration experiment of medical waste was carried out in a mobile animal carcass incinerator. Simulated medical waste (69% cotton, 1.5% wood product, 4.5% mask and 25% moisture) was used as raw material. The temperature trend of first and second combustion chamber, the operating conditions and the emission characteristics of gaseous pollutants were studied. The results indicated that the temperature of first combustion chamber can be maintained at 550-650 °C without external heating, while in the final stage a burner was used to realize the burnout of material. The temperature of the second combustion chamber was always lower than that of the first combustion after the burner stopped working. The concentration of CO emission in flue gas was high due to the low disposal efficiency of the mobile incinerator, while NO_X and SO₂ emission concentrations were far below the standard limit value (GB 18484-2001).

Intraoperative waste segregation initiative among anesthesia personnel to contain disposal costs

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.

Hepatitis B virus infection and its associated factors among medical waste collectors at public health facilities in eastern Ethiopia: a facility-based cross-sectional study

BACKGROUND

The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia.

METHODS

A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant.

RESULTS

From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity.

CONCLUSION

This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.

COVID-19 pandemic: Solid waste and environmental impacts in Brazil

The World Health Organization has recently declared South America the new epicenter of the COVID-19 pandemic, as Brazil has become one of the most affected countries. Besides public health and economic impacts, social isolation has also caused indirect environmental effects. The aim of this study was to assess environmental impacts caused by shifts on solid waste production and management due to the COVID-19 pandemic in Brazil. We have analyzed data from 30 cities, representing a population of more than 53.8 million people (25.4% of the Brazilian population). Unexpectedly, solid waste production in the main cities in Brazil has decreased during the social isolation period, possibly because of reduced activity in commercial areas. The latest data on solid waste in Brazil have revealed that more than 35% of medical waste has not been treated properly. Furthermore, improper disposal of facemasks has been reported in several cities and may increase the risk for COVID-19 spread. The suspension of recycling programs has hindered natural resources from being saved, with emphasis on 24,076 MWh of electric power and 185,929 m³ of potable water - respectively enough to supply 152,475 households and 40,010 people, over a month. Furthermore, total sale price for recyclable materials during the suspension of recycling programs reaches more than 781 thousand dollars, being these materials disposed in landfills - demanding an extra volume of 19,000 m³ - reducing landfill lifespan, and hence causing a double loss: economic and environmental.

Coronavirus disease 2019 (COVID-19) induced waste scenario: A short overview

The COVID-19 pandemic and lockdown situation have shown both positive and negative effects on the environmental aspects. With an unprecedented rate the different types of waste volume have up surged along with the COVID-19 contamination rate. As the situation has mandated people as well as the most infected persons to stay at home, the amount of generated hazardous waste is 3.40 kg that can be expected daily from each infected person. China and other countries have seen a massive increment in the hazardous waste generation (about 600 % increase in Hubei province) amount. While dealing with this sudden increase in waste amount, the conventional incineration facilities have been outstripped and waste management industry is facing an immense pressure over handling hazardous waste generated from COVID-19 infected patients. Alongside with the hazardous waste volume, single-use plastic items and personal protective equipment (PPEs) have induced a new type of "PPE pollution" in the land and aquatic environment. The current review provides a countrywide waste generation amount, estimated using the infected number of cases for some selected countries. In contrast with the poor waste management noticed during this pandemic, some suggested approaches towards a better waste management service and future implications of waste management are discussed with viable consideration for the waste workers.

Utilization of greenhouse effect for the treatment of COVID-19 contaminated disposable waste - A simple technology for developing countries

Countries with abundant solar radiation have the potential to invest in simple technologies for deactivation of many bacteria and viruses in medical solid waste. In addition to the traditional Infection and Prevention Control (IPC) measures, these simple technologies contribute to better protection of health care workers in countries with compromised solid management schemes. Monitoring of temperature, relative humidity and ultraviolet inside containers soundly designed to collect disposal infectious waste illustrated to deactivate several viruses and bacteria. Casanova et al., 2010, used some surrogate viruses to overcome the challenges of working with SARS-CoV, concluded that by temperature above 40 °C most of viruses become below levels of detection after 90 min. Here we are proposing a model of a simple transparent container almost 200 L in volume that allow solar energy to be accumulated inside. In summer conditions in the testing site, temperature inside the container reached above 50 °C when the ambient air temperature was around 30 °C. The container was built using epoxy glass to guarantee maximum heat penetration. Actual temperature measurement inside the container was measured in real time against ambient air temperature. We present a mathematical model for predication of maximum temperature at different positions inside the container and their relation to different ambient air temperature scenarios. The mathematical formulas used are based on the conservation laws and a good agreement of a full month of field measurements were obtained. Even in winter conditions in many of developing countries air temperature can maintain levels above 20 °C, which will produce temperature around 30 °C and viruses can reach levels below detection limit in maximum 3 h.