Waste Management & Research: The Journal for a Sustainable Circular Economy

The objectives of this study were the assessment of healthcare waste management and the characterization of healthcare waste material generated in the hospitals in Nablus city, Palestine, and furthermore, to estimate the prevalence of hepatitis B among the cleaning personnel working in these hospitals. The medical waste generation rate in kg per bed per day was between 0.59 and 0.93 kg bed^{— 1} day^—1. The waste generation rate in the healthcare facilities of Nablus city hospitals was similar to some other developing countries; however, the percentage of medical wastes in the total waste stream was comparatively high. The density of medical waste at the four hospitals studied ranged between 144.9 and 188.4 kg m^{— 3} with a mean value of 166.7 kg m^—3. The waste segregation and handling practices were very poor. Other alternatives for waste treatment rather than incineration such as a locally made autoclave integrated with a shredder should be evaluated and implemented. The system of healthcare waste management in Nablus city is in need of immediate improvement and attention. Formulating rules and guidelines for medical waste and developing strategies for overcoming the obstacles related to waste management should be considered as an urgent matter.

It is more than 5 years since the prescribed deadline, 30 December 2002, for all categories of towns covered by the Biomedical Waste Management (BMW) Rules 1998 elapsed. Various reports indicate that the implementation of the BMW Rules is not satisfactory even in the large towns and cities in India. Few studies have looked at the `macro system' of the biomedical waste management in India. In this context the present study describes the role of the important stakeholders who comprise the `macrosystem' namely the pollution control board, common waste management facilities, municipal corporation, state government (Directorate of Medical Education and Health Systems Development Project), professional agencies such as the India Medical Association and non-governmental organizations, in the implementation of BMW rules in a capital city of a state in south India. Brief descriptions of the `micro-system' (i.e. biomedical waste management practices within a hospital) of six hospitals of different types in the study city are also presented.

After decades of turmoil and international sanctions much of the key civil infrastructure within Iraq has fallen into disrepair, leading to a considerable decline in the provision of basic and essential municipal services. This is particularly true of waste and resource management services that have seen years of underdevelopment and deterioration. This has resulted in a lack of provision of basic public services in the waste sector which have been replaced by a burgeoning unregulated informal market in waste collection, disposal and recycling. In response, a National Solid Waste Management Plan (NSWMP) for Iraq was developed in 2007, to plan for the strategic development of all aspects of waste management in the country over the coming 20 years. In particular, the NSWMP focuses on policy development and integrated planning regarding regulatory framework, economic aspects, institutional capacity, citizen and technical education, and technical and operational development. This paper summarizes the key objectives, challenges and subsequent recommendations contained in the NSWMP for Iraq.

This article presents the results of a descriptive cross-sectional study on medical waste management in Tabriz (Iran's fourth largest city). The study was conducted in 10 of 25 active hospitals of the city in the summer of 2007. The methodology of the present study was based on data collected from hospitals through a checklist, site visits (observation), and quantity analysis by weight. The results indicated that more than 13.59 tonnes day^—1 of total medical waste and 4.06 tonnes day^—1 of hazardous-infectious medical waste are generated by the active hospitals of the city. Currently, there are no practical instructions, or suitable supervision on different levels of waste management. The health authorities and hospital managers do not accept sufficient responsibility for the medical waste due to financial problems and the lack of awareness regarding the hazards of medical waste. Segregation and minimization of waste are not carried out correctly in any of the hospitals. The use of protective measures by staff and temporary storage areas was not in agreement with standards in 70 and 60% of the hospitals in the present study, respectively. About 50% of the hospitals had been equipped with an incinerator, but all but one (10%) of them had been phased out due to operation and maintenance problems, air pollution, etc. Almost all of the hospitals have a waste management officer, but there is not an effective training programme for the staff. Infectious-hazardous medical waste is mixed with general waste, and it is disposed of in a municipal waste landfill, which is an unsanitary dumpsite. Illegal segregation and recycling of medical waste is carried out at the final disposal site; therefore, there are concerns about environmental pollution and the transmission of infectious diseases. It is proposed that, through the allocation of increased budgets, implementation of integrated segregation, minimization of waste, and creation of a training programme in the hospitals, the quantity of medical waste would be decreased (by about 70.11%). Considering the previous unsuccessful experience of on-site incineration in Tabriz (and in Iran's other large cites), an amendment should be made to Iran's current hazardous waste regulations to have infectious-hazardous waste sent to a central off-site autoclave or incinerator for treatment. The off-site autoclave would have some advantages, such as decreased air pollution. Of course, some health officials oppose this plan. To test this plan and receive the official's approval, a central off-site autoclave can be put into practice as a pilot.

Medical waste refers to those hazardous waste materials generated by healthcare activities, including a broad range of materials, and remains as an issue on both public health and environment. In China, there was inadequate information on the implementation of management systems in hospitals based on the national regulatory framework. The objectives of this study were to assess the current situation of medical waste management and to identify factors determining the implementation of a management system based on the national regulatory framework in hospitals. We investigated 23 general hospitals in both urban and rural areas of Shandong Province, China, by both quantitative and qualitative approaches. The medical waste generation rate was 0.744, 0.558 and 1.534 kg bed^{— 1} day^—1 in tertiary hospitals, urban secondary hospitals and county hospitals, respectively. There is a wide disparity between implementation in tertiary, secondary and county hospitals. With increasing financial, technological, and materials investment, a management system has been established in tertiary and secondary hospitals. Financial support and administrative monitoring by the government is urgently needed to build a sound management system in hospitals located at remote and less-developed areas. In those areas issues in the financial, administrative and technical aspects should be further examined.

The safe management of potentially infectious healthcare waste is gaining increasing worldwide importance. In developing countries, simple incinerators are used for the treatment of this type of waste stream. However, as these incinerators produce high emissions and represent the main generators of dioxin and furans in these countries, alternative and cost-effective solutions are needed. As steam treatment systems do not produce persistent organic pollutants, the use of existing (older) medical autoclaves could represent a solution for the treatment of infectious waste. ETLog Health EnviroTech & Logistics, the German-based consulting and engineering company carried out the first research into whether gravity air displacement autoclaves can be used for the safe decontamination of infectious waste. The research showed that it is not possible to decontaminate waste using this type of autoclave. A subsequent research and development phase might, however, make it possible to develop a new process cycle. Tests carried out on the basis of international standards and norms showed that by applying this process cycle and using an add-on set, it is possible to treat healthcare waste using the existing stock of older medical autoclaves. The process cycle and the add-on set developed were tested under existing conditions in Hanoi, Vietnam using the treatment cycle developed for a 13-year-old autoclave. All the parameters for infectious waste decontamination were reached. As modified autoclaves prevent the emission of toxic substances, this approach presents an interim solution, which avoids the impacts on human health and the environment caused by the incineration of healthcare waste.

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient^—1 day^—1 and 26 L outpatient^—1 day^{— 1}, respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

Since the creation of the National Health Service (NHS) in the United Kingdom in 1948 there have been significant changes in the way waste materials produced by healthcare facilities have been managed due to a number of environmental, legal and social drivers. This paper reviews the key changes in legislation and healthcare waste management that have occurred in the UK between 1948 and the present time. It investigates reasons for the changes and how the problems associated with healthcare wastes have been addressed. The reaction of the public to offensive disposal practices taking place locally required political action by the UK government and subsequently by the European legislature. The relatively new UK industry of hazardous healthcare waste management has developed rapidly over the past 25 years in response to significant changes in healthcare practices. The growth in knowledge and appreciation of environmental issues has also been fundamental to the development of this industry. Legislation emanating from Europe is now responsible for driving change to UK healthcare waste management. This paper examines the drivers that have caused the healthcare waste management to move forward in the 60 years since the NHS was formed. It demonstrates that the situation has moved from a position where there was no overall strategy to the current situation where there is a strong regulatory framework but still no national strategy. The reasons for this situation are examined and based upon the experience gained; suggestions are made for the benefit of countries with systems for healthcare waste management still in the early stages of development or without any provisions at all.

This paper reviews the current generation and management of healthcare waste in the United Kingdom, with a focus on that produced from healthcare provision in the National Health Service. While the current capacities of large-scale off-site treatment systems are adequate, there are a number of logistical factors that must be considered in future. These include variations in arisings from each country and from various regions within each country, the age and location of treatment/disposal facilities, the quantities, types and sources of healthcare waste, and the impact of waste minimization and recycling strategies. Managing UK healthcare waste is a complex issue that requires the correct technologies and capacities to be available. With increasing quantities and costs there is urgent need for future planning, and healthcare waste issues need to be addressed from a UK-wide perspective. Holistic strategies need to incorporate both minimization and segregation, with treatment using a combination of incineration and alternatives treatment technologies. The need for more research and accurate data to provide an evidence-base for future decision-making is highlighted.

Hospital waste materials pose a wide variety of health and safety hazards for patients and healthcare workers. Many of hospitals in Iran have neither a satisfactory waste disposal system nor a waste management and disposal policy. The main objective of this research was to investigate the solid waste management in the eight teaching hospitals of Iran University of Medical Sciences. In this cross-sectional study, the main stages of hospital waste management including generation, separation, collection, storage, and disposal of waste materials were assessed in these hospitals, located in Tehran city. The measurement was conducted through a questionnaire and direct observation by researchers. The data obtained was converted to a quantitative measure to evaluate the different management components. The results showed that the waste generation rate was 2.5 to 3.01 kg bed^—1 day^—1, which included 85 to 90% of domestic waste and 10 to 15% of infectious waste. The lack of separation between hazardous and non-hazardous waste, an absence of the necessary rules and regulations applying to the collection of waste from hospital wards and on-site transport to a temporary storage location, a lack of proper waste treatment, and disposal of hospital waste along with municipal garbage, were the main findings. In order to improve the existing conditions, some extensive research to assess the present situation in the hospitals of Iran, the compilation of rules and establishment of standards and effective training for the personnel are actions that are recommended.

In the paper, the practical problem of analysing in an integrated way the performance of provincial waste systems is approached, in the framework of the Strategic Environmental Assessment (SEA). In particular, the in itinere phase of SEA is analysed herein. After separating out a proper group of ambits, to which the waste system is supposed to determine relevant impacts, pertinent sets of single indicators are proposed. Through the adoption of such indicators the time trend of the system is investigated, and the suitability of each indicator is critically revised. The structure of the evaluation scheme, which is essentially based on the use of ambit issues and analytical indicators, calls for the application of the method of the Dashboard of Sustainability for the integrated evaluation of the whole system. The suitability of this method is shown through the paper, together with the possibility of a comparative analysis of different scenarios of interventions. Of course, the reliability of the proposed method strongly relies on the availability of a detailed set of territorial data. The method appears to represent a useful tool for public administration in the process of optimizing the policy actions aimed at minimizing the increasing problem represented by waste production in urban areas.

With the purpose of assessing the environmental impacts and benefits of the current municipal solid waste management system and two modified systems, EASEWASTE, a life-cycle-based model, was used to evaluate the waste system of Hangzhou city in China. An integrated model was established, including waste generation, collection, transportation, treatment, disposal and accompanying external processes. The results showed that CH₄ released from landfilling was the primary pollutant contributing to global warming, and HCl and NH₃ from incineration contributed most to acidification. Material recycling and incineration with energy recovery were important because of the induced savings in material production based on virgin materials and in energy production based on coal combustion. A modified system in which waste is transported to the nearest incinerators would be relatively better than the current system, mainly due to the decrease of pollution from landfilled waste and the increase in energy production from waste avoiding energy production by traditional power plants. A ban on free plastic bags for shopping was shown to reduce most environmental impacts due to saved oil resources and other materials used in producing the plastic bags. Sensitivity analysis confirmed the robustness of the results. LCA methodology and a model like EASEWASTE are very suitable for evaluating the overall environmental consequences, and can be used for decision support and strategic planning in developing countries such as China where pollution control has become increasingly important with the rapid increase of waste generation as well as the increasing public awareness of environmental protection.