POST 01307E: HEALTHCARE WASTE MANAGEMENT: NEED FOR TRAINING/SUPERVISION FOLLOW-UP ON POSTS 01295E, 01296E & 01305E 19 AUGUST 2008 ******************************************* Dear Friends, In Developing country settings (like India) Biomedical Waste Management is given low priority in absence of quality training and poor supervision. In a study conducted by dept. of community medicine, of a medical college in Himachal Pradesh, India, (unpublished), the knowledge regarding Biomedical waste management and desirable practices was low especially among sweepers who collect and dispose the waste. This was common even among those who were trained. What is required is good quality trainings and proper supervision of waste segregation and handling. We still have to address the basic issues in developing countries. Incinerators often go out of order (? due to waste not being segragated) and then remain out of order for long periods in absence of appropriate mechanisms to maintain them.Rajesh Sood ([email=drrksood@GMAIL.COM]drrksood@GMAIL.COM[/email]) -------- The references below are cross-posted from SIGN (30 July 2008) with thanks. 1. Report: Hospital waste management--awareness and practices: a study of three states in India (Waste Management Research. 2008 Jun: 26(3): 297-303; Rao PH, Center for Human Development, Administrative Staff College of India, Bella Vista, Khairatabad, Hyderabad, India. [firstname.lastname@example.org]email@example.com[/email] ([firstname.lastname@example.org]email@example.com[/email])) The study was conducted in Andhra Pradesh, Maharashtra and Uttar Pradesh in India. Hospitals/nursing homes and private medical practitioners in urban as well as rural areas and those from the private as well as the government sector were covered. Information on (a) awareness of bio-medical waste management rules, (b) training undertaken and (c) practices with respect to segregation, use of colour coding, sharps management, access to common waste management facilities and disposal was collected. Awareness of Bio-medical Waste Management Rules was better among hospital staff in comparison with private medical practitioners and awareness was marginally higher among those in urban areas in comparison with those in rural areas. Training gained momentum only after the dead-line for compliance was over. Segregation and use of colour codes revealed gaps, which need correction. About 70% of the healthcare facilities used a needle cutter/destroyer for sharps management. Access to Common Waste Management facilities was low at about 35%. Dumping biomedical waste on the roads outside the hospital is still prevalent and access to Common Waste facilities is still limited. Surveillance, monitoring and penal machinery was found to be deficient and these require strengthening to improve compliance with the Bio-medical Waste Management Rules and to safeguard the health of employees, patients and communities. 2. Report: Healthcare waste characterization in Chittagong Medical College Hospital, Bangladesh (Waste Management Research 2008 Jun: 26(3): 291-6; Alam MM, Sujauddin M, Iqbal GM, Huda SM; Institute of Forestry and Environmental Sciences, Chittagong University, Chittagong, Bangladesh) Healthcare waste management (HCWM) options are inconsistent in Bangladesh. One of the first critical steps in the process of developing a reliable waste management plan requires a comprehensive understanding of the quantities and characteristics of the waste that needs to be managed. This study took into consideration both the quantity and quality of the generated waste to determine the generation rates and physical properties of healthcare waste (HCW) in Chittagong Medical College Hospital (CMCH) and also to estimate the amount of infectious and non-infectious waste generated in different wards. CMCH, the second largest hospital in Bangladesh, comprises 34 wards, 12 of which were selected randomly. Waste materials were collected from these wards and then segregated and weighed. Waste generation per day was found to be 73.22 kg/ward, 1.28 kg/bed and 0.57 kg/patient. A total of 2490 kg of HCW was produced each day in CMCH (37% being infectious and the rest being non-infectious waste). Infectious waste was 27.07 kg per ward, 0.47 kg per bed and 0.21 kg per patient and the non-infectious waste was 46.15 kg per ward, 0.81 kg per bed and 0.36 kg per patient per day. HCW comprised eight categories of waste materials with vegetable/food waste being the largest component (50.21%) and varied significantly (P < 0.05) among the 12 different wards studied. The greatest amount of HCW was recorded (154 kg) in Orthopaedics followed by 96.66 kg in the Medicine Unit-3 and the smallest amount was recorded in Casualty (8.79 kg). The amount of HCW was positively correlated with the number of occupied beds (rxy = 0.79, P < 0.01). There is no structured form of medical waste treatment in CMCH and most waste materials are dumped in open areas for natural degradation or re-sold by scavengers. It is essential to develop a national policy and implement a comprehensive action plan for HCWM that will provide environmentally sound technological measures to improve HCWM in Bangladesh. 3. Modelling seasonal variation in biomedical waste generation at healthcare facilities (Waste Management Research: 2008 Jun: 26(3): 241-6; Katoch SS, Kumar V; Department of Chemical Engineering, Thapar Institute of Engineering & Technology, Deemed University, Patiala, India.) A mathematical model can help waste planners to optimize waste management systems related to environmental protection. It can also help government bodies set guidelines and regulations, and evaluate prevailing strategies for handling and disposal of waste. In this paper, a technique to develop a mathematical model to correlate the generation rate of biomedical waste (contaminated with blood and body fluid) as a function of bed occupancy and type of ailment (in terms of seasonal changes) using data for two consecutive years from three different healthcare facilities is presented. The data exhibit different trends in biomedical waste generation rates and number of beds occupied in two different years. However, the seasonal variation in biomedical waste production rate remained nearly the same during these 2 years. The fixed trend in biomedical waste generation rate in two consecutive years could be due to similar seasonal illnesses pattern and social factors. 4. Utilizing a 'systems' approach to improve the management of waste from healthcare facilities: best practice case studies from England and Wales (Waste Management Research: 2008 Jun: 26(3): 233-40; Tudor TL, Woolridge AC, Bates MP, Phillips PS, Butler S, Jones K. SITA Centre for Sustainable Wastes Management, University of Northampton, Northampton, UK. [firstname.lastname@example.org]email@example.com[/email] ([firstname.lastname@example.org]email@example.com[/email])) Changes in environmental legislation and standards governing healthcare waste, such as the Hazardous Waste Regulations are expected to have a significant impact on healthcare waste quantities and costs in England and Wales. This paper presents findings from two award winning case study organizations, the Cardiff and Vale NHS Trust and the Cornwall NHS Trust on 'systems' they have employed for minimizing waste. The results suggest the need for the development and implementation of a holistic range of systems in order to develop best practice, including waste minimization strategies, key performance indicators, and staff training and awareness. The implications for the sharing of best practice from the two case studies are also discussed. 5. Resolving complexities in healthcare waste management: a goal programming approach (Waste Management Research: 2008 Jun: 26(3): 217-32; Chaerul M, Tanaka M, Shekdar AV; Graduate School of Natural Science and Technology, Okayama University, Japan. [firstname.lastname@example.org]email@example.com[/email]) ([firstname.lastname@example.org]email@example.com[/email]) A planning model is presented that is based on a trans-shipment goal programming approach wherein the waste flow is optimized for multiple objectives under different priority structures or with different relative importance (weights). The use of the model is demonstrated as a decision-making tool that would help the management to understand the effects of their policies on the system performance. The model is validated for a case application representing a real-life situation. It can be easily seen that, in the case in which the management is biased toward a higher level of safety protection towards infection control, they have to compromise on cost control and to some extent on environmental pollution control. 6. Healthcare waste management in the capital city of Mongolia (Waste Management: 2008: 28(2):435-41. Epub 2007 April; Shinee E, Gombojav E, Nishimura A, Hamajima N, Ito K; Department of Young Leaders' Program, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya 466-8550, Japan: [firstname.lastname@example.org]email@example.com[/email] ([firstname.lastname@example.org]email@example.com[/email])) Inconsistencies are present in the management options for healthcare wastes in Mongolia. One of the first critical steps in the process of developing a reliable waste management plan requires the performance of a waste characterization analysis. The objectives of this study were an assessment of the current situation of healthcare waste management (HCWM) and characterization of healthcare wastes generated in Ulaanbaatar. A total about 2.65 tonnes of healthcare wastes are produced each day in Ulaanbaatar (0.78 tons of medical wastes and 1.87 tons of general wastes). The medical waste generation rate per kg/patient-day in the inpatient services of public healthcare facilities was 1.4-3.0 times higher than in the outpatient services (P ([firstname.lastname@example.org]email@example.com[/email])) Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana. Post generated using Mail2Forum (http://www.mail2forum.com)
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