Cloud decision support framework for treatment technology selection of health-care waste

With the attention of people to environmental and health issues, health-care waste (HCW) management has become one of the focus of researchers. The selection of appropriate HCW treatment technology is vital to the survival and development of human beings. In the assessment process of HCW disposal alternative, the evaluation information given by decision makers (DMs) often has uncertainty and ambiguity. The expression, transformation and integration of this information need to be further studied. We develop an applicable decision support framework of HCW treatment technology to provide reference for relevant staff. Firstly, the evaluation information of DMs is represented by interval 2-tuple linguistic term sets (ITLTs). To effectively express qualitative information, the cloud model theory is used to process the linguistic information, a novel concept of interval 2-tuple linguistic integrated cloud (ITLIC) is proposed, and the relevant operations, distance measure and possibility degree of ITLICs are defined. Moreover, a weighted Heronian mean (HM) operator based ITLIC is presented to fuse cloud information. Secondly, the HCW treatment technology decision support model based on the BWM and PROMETHEE is established. Finally, the proposed model is demonstrated through an empirical example, and the effectiveness and feasibility of the model is verified by comparison with extant methods.

Practices of waste management in health care facilities in Nepal's Biratnagar metropolitan city

Biratnagar is a medical referral centre with tertiary health care in Eastern Nepal. The city population is 202,061, according to the 2011 census. There are 35 Health Care Facilities (HCFs) in the city as of 2014. There are 7 HCFs, 2 non-governmental HCFs, and 26 private HCFs. In 2014, the District Public Health Office Morang, the Biratnagar municipality, and the private sector collaborated to check Biratnagar's health care waste management. Investigators performed a semi-structured questionnaire and checklists while visiting health care sites. According to the survey results, 10% of HCFs use incinerators. 80% of HCFs separate their garbage, 60% use needle destroyer machines, and 50% use coloured dustbins to separate different sorts of medical waste. The bed occupancy rate is 78%. Every day, one sweeper looks for 6.66 beds. Even 10% of HCFs let their waste out in the open. HCFs do not have enough capacity for waste disposal facilities. Thus, HCFs pay the municipality Rs. 1500- 15000 a month to have the facility's waste removed. In the municipality tractor, they are hauling medical garbage and home rubbish. As a result, the city discharges health care waste with household waste in the Singhiaya River. These actions endanger public health. Biratnagar city generates 118 Kgs of hazardous health care waste daily, necessitating immediate treatment. Biratnagar Municipality should collaborate with partners to develop a short and long-term strategy.

Assessment of health-care waste generation and its management strategy in the Gaza Strip, Palestine

The situation of health-care waste in the Gaza Strip was threatening the environment and the public health due to the absence of appropriate health-care waste (HCW) handling, treatment, and disposal. In 2016, the total amount of HCW generated was estimated about 7199 kg day−1. Around 20% of the wastes was infectious, and the on-site segregation was done only for sharps in most health care facilities, while other infectious wastes were comingled with noninfectious normal wastes. In 2017, a new strategy for the health-care waste management (HCWM) was adopted. The strategy stated the necessity to segregate the HCW into three categories at the generation source to sharps, infectious wastes, and noninfectious wastes. The strategy was implemented over 40 clinics. The proper on-site segregation of the infectious and sharps showed that 2.4 kg day−1 and 0.7 kg day−1 of wastes is generated from UNRWA and Ministry of Health (MOH) clinics, respectively. This generation quantity accounts for a rate of 11 g per outpatient at UNRWA clinics and a ratio of 9.5 g per outpatient at MOH clinics. These quantities account for 33% and 54% of the total waste from UNRWA and governmental clinics in South and Middle Gaza.

Assessing the management of healthcare waste for disease prevention and environment protection at selected hospitals in Kinshasa, Democratic Republic of Congo

Incineration is the most used healthcare waste (HCW) disposal method. Disease outbreaks due to Ebola virus and SARS-CoV2 require attention to HCW management to avoid pathogens spread and spillover. This study describes HCW management prior to incineration and hospital incinerators performance by analysing bottom ashes from hospitals in Kinshasa, Democratic Republic of Congo. We used semi-structured interviews to capture information on pre-incineration waste management and analysed the chemical composition of 27 samples of incinerator bottom ashes using the energy dispersive X-ray fluorescence. Neither sorting nor waste management measures were applied at hospitals surveyed. Incinerator operators were poorly equipped and their knowledge was limited. The bottom ash concentrations of cadmium, chromium, nickel and lead ranged between 0.61–10.44, 40.15–737.01, 9.11–97.55 and 16.37–240.03 mg kg−1, respectively. Compared to Chinese incinerator performance, the concentrations of some elements were found to be lower than those from China. This discrepancy may be explained by the difference in the composition of HCW. The authors conclude that health care waste in Kinshasa hospitals is poorly managed, higher concentrations of heavy metals are found in incinerator bottom ashes and the incinerators quality is poor. They recommend the strict application of infection prevention control measures, the training of incinerator operators and the use of high-performance incinerators.

Reusability of autoclaved 3D printed polypropylene compared to a glass filled polypropylene composite

Health care waste can be a costly expenditure for facilities as specific disposal methods must be used to prevent the spread of pathogens. If more multi-use medical devices were available, it could potentially relieve some of this burden; however, sterilization between uses is important in preventing disease transmission. 3D printing has the ability to easily create custom medical devices at a low cost, but the majority of filaments utilized cannot survive steam sterilization. Polypropylene (PP) can withstand autoclave temperatures, but is difficult to print as it warps and shrinks during printing; however, a composite PP filament reduces these effects. Commercially available PP and glass filled PP (GFPP) filaments were successfully 3D printed into 30 × 30 × 30 mm cubes with no shrinking or warping and were autoclaved. The 134 °C autoclave temperature was too high as several cubes melted after two to three rounds, but both PP and GFPP cubes displayed minimal changes in mass and volume after one, four, seven, and ten rounds of autoclaving at 121 °C. GFPP cubes autoclaved zero, four, seven, and ten times had significantly smaller average compressive stress values compared to all PP groups, but the GFPP cubes autoclaved once were only less than PP cubes autoclaved zero, seven and ten times. GFPP cubes autoclaved zero, one, four, and seven times also deformed less indicating that the embedded glass fibers provided additional strength. While a single method was found that successfully printed PP and GFPP cubes that were able to survive up to ten rounds of autoclaving, future work should include further investigation into the mechanical properties and increasing the number of autoclave rounds.

Biomedical Waste Management

Bio medical waste (BMW) disposal is a very important yet a challenging task. Health care waste contains potentially harmful microorganisms, which can infect hospital patients, health workers, and the general public. Exposure to hazardous health care waste can result in disease or injury. The Government of India has been laying down rules, namely, Bio Medical Waste (Management and Handling) Rules, in 1998, COVID-19 pandemic and its consequent biomedical waste is an unprecedented challenge worldwide. Biomedical waste generated during COVID-19 patient isolation, testing and care needs special consideration as it challenges the previous notion that only 15–20% of waste can be considered infectious. With establishment of new home quarantine facility, isolation/quarantine centers the chances of general waste getting contaminated with biomedical waste has increased exponentially. The key step in COVID19 waste management is segregation of biomedical waste from solid waste. Waste generated from COVID19 patients is like any other infectious waste, therefore creating public awareness about the COVID19 waste hazards and segregation at source is highlighted in all guidelines as a recommendation.

Comparison of Health-care Waste Management in Urban and Rural Areas in Iran: Application of Multi-criteria Decision Making Method

Background: The global population has grown and is still growing. This growth is happening in more cities than in rural areas, given the continual search for economic opportunities. The implication of this growth is the growth of healthcare centers to meet the growing healthcare demand. Accordingly, healthcare waste production has posed a big challenge to health waste disposal and management. Objectives: This study aimed to prioritize and select the best method of waste management in the health sector with multi-criteria decision making (MCDM) approaches. Methods: The present cross-sectional study was carried out to select the best method of managing healthcare wastes through MCDM approaches in Qazvin. The sample was selected and assigned to two groups of 28 experts (five categories) who evaluated the criteria and a group of 22 individuals (four categories) to rank disposal methods of healthcare waste. First, six waste disposal methods and 12 criteria for designing a questionnaire were identified. After designing the questionnaire, the analytic hierarchy process (AHP) was used to calculate the weights of the criteria. Then, the TOPSIS method was used to rank different waste disposal methods. We used EC (ver. 8), Excel (Microsoft, 2007), and Lingo (ver. 14) for analyzing the data. Results: Concerning the rank of health waste disposal methods based on common existing criteria, urban and rural areas should use different disposal methods. The best disposal methods are irradiation (0.839) and microwave (0.794) in urban areas and steam sterilization (0.867) and microwave (0.840) in rural areas. In both areas, incineration was ranked the last. Conclusions: To achieve the effective disposal and safety of health waste in urban and rural areas, varied but applicable disposable methods should be used for the management of health waste disposal.

COVID-19 Biomedical Waste Management: Knowledge Assessment Among Medical Professionals in a COVID-19 Dedicated Hospital, a Cross Sectional Study.

Background Nations have faced significant challenges with the COVID-19 related biomedical waste since its outbreak. Before the pandemic, Indian hospitals typically generated 500g of BMW per bed each day, which has now risen to about 2.5-4 kg per bed per day. Proper BMW aims to reduce waste generation, ensures efficient collection, handling and safe disposal that it controls infection and improves safety for the medical professionals. Hence, the present study was conducted to assess the level of knowledge among medical professionals regarding biomedical waste segregation , transport and treatment and thereafter provide constructive suggestions to reduce mismanagement practices. Methodology An e-survey was done to assess the knowledge and awareness of management of Biomedical Waste generated due to Covid-19 among Medical Professionals (students, residents and consultants) of tertiary care hospital of North India. Result The average knowledge score about BMW waste generated due to Covid-19 was found to be: for segregation - 27.46%, 59.615%, and 49.8%; transport of waste from site of generation to the site of disposal- 63.66%, 89.1% and 95.2% ; disposal of waste generated- 29%, 71.96%, and 68.24% in students, residents, and consultants respectively. Overall, the knowledge score was 41.4%, 67.98%, and 61.34% among the students, residents and consultants respectively. We found that participants with greater years of experience (residents and consultants) had better knowledge compared to that of the students(p<0.05). Discussion Our study found that the mean score was 56.9% which is comparably more than the knowledge score of few Low and Middle Income Countries but less than the knowledge score of some European countries. Studies have found that the chances of infection directly correlates with the low level of knowledge. This underlines that training aspects of health-care waste management should be strengthened, not only for the practising medical professionals but also of the students so that the current, existing, and future regulations are practiced diligently and uniformly. Hence, it is important that we strengthen the training aspect of medical professionals. Periodic evaluation and assessment should become routine to enforce adherence to waste management.

Improving Health Care Waste Management in Africa: Action Research on how can Staff of Makerere University Hospital be involved in overcoming their Occupational Hazards?

Background: Action research is a participatory, democratic process concerned with developing practical knowledge in the pursuit of worthwhile human purposes. In a health care setting, numbers of people go there for prevention, treatment, and care including rehabilitation. All these are vulnerable to the hazardous wastes which are generated within such a setting if not properly managed. Health care settings become more detrimental places where diseases can be transmitted and pollutants to the natural environment thus becoming harmful to the whole community at large. The research is aimed at creating both staff and clients with a conducive environment to work and live in with reduced chances of morbidity, injury, or harm occurring secondary to poor waste management. Methodology: This study set out to identify the health-related challenges faced by Makerere University Hospital, determine the causes of poor health care wastes management, and setting up the appropriate mitigating solutions. Data was generated using interviews for primary data and documents focused on group discussions for secondary data. Multi-voting and nominal techniques were used to identify the priority health problem. A problem and solution tree were used to provide an overview of all the known causes and effects to the identified problem and their solutions. Results: Most of the respondents were women 26(52%) and men were 24(48%). These were Classified into staff with clinical background 32(64%) and non-clinical staff 18(36%). Several problems were listed among which included a need to have an administrator who is medical personnel. Conclusion and recommendations: Poor health care waste management was the most pressing problem in Makerere University Hospital. Collaborating with the hospital community to address the poor waste management approaches, helped to improve the waste segregation, storage, transportation, and disposal in conjunction with strengthening staff empowerment that both contribute to good health living in such health settings.