Hospital Stakeholders’ Perception on Environmental Effects Related to Biomedical Waste in Togo’s University Hospitals (UHC) in 2021

Introduction: Given its effects, hospital waste is an environmental concern and a threat to health personnel, users of health services and neighboring populations. Our objective was to assess the perception of health care stakeholders on the environmental effects related to biomedical waste produced in Teaching Hospitals (CHU) in Togo in 2021. Methods: This was a cross-sectional study held from June 24 to August 28, 2021. It targeted three university hospitals, 340 health care providers and services selected by a probabilistic method with a simple random technique in 25 services, 72 directors, deputy directors, supervisors and heads of services, 27 collection and incineration agents selected by a non-probabilistic method with a reasoned choice technique, 44 patients and attendants and 36 householders of neighboring residents selected by a non-probabilistic method with an accidental choice technique. Variables such as the spreading of disease vectors, soil, air and water contamination, the presence of unpleasant odors and unsightly living conditions were assessed. Results: According to the respondents, biomedical waste causes the proliferation of vectors (55.3%), an unsightly environment inside the hospital (47.1%), and unpleasant odors (61.2%). Incineration operations disturb hospital residents (52.8%), according to the householders of the residents. During observation, we note deposits of waste that have not been destroyed and wastewater flowing in some places. Conclusion: Biomedical waste in Togo’s university hospitals generates environmental effects and therefore potentially high risks for human health. Improving their management should be a concern for all hospital actors.

Lagos State Hospital Waste Management Practices: A Descriptive Overview with Stakeholders’ Role and Key Recommendations

Background: Waste generation and its disposal is an essential issue in the sustainability of the environment and the planet’s future. Waste management is essential across sectors, likewise the health sector. Therefore, there is a need to employ extra care and attention to handling waste generated from healthcare facilities to avoid the dangers of poor biomedical waste management. We carried out this study to examine the waste management practice in healthcare facilities in Lagos State. Methods: The study was a descriptive survey carried out in one-thousand two hundred and fifty-six (1256) healthcare facilities in Lagos State. Nine hundred sixty-nine (969) of these facilities are located in urban areas, while two hundred and eighty-seven (287) are rural. The facilities studied are government/public health facilities (15.45%), private-for-profit facilities (82.88%), NGOs, Mission/Faith-Based medical facilities (1.67%). The data collected were analyzed using descriptive statistics. Specifically, we utilized bar charts, frequency, and percentage. Result: The result shows that 98.4% (1236) of the studied facilities are registered with the Lagos State Waste Management Authority (LAWMA), while 1.6% (20) are not registered. 98.5% (191) of the 194 government-owned facilities, 98.5% (1025) of the 1041 private-for-profit facilities, and 98.2% (20) of the 21 NGOs/faith-based health facilities are registered with Lagos State Waste Management Authority. The result also shows that 94% of the healthcare facilities studied in Lagos State use color-coded waste bags to segregate waste at the point of origin. 58.7% of the facilities use red-colored bags, 33.3% use yellow-colored bags, 10.7% use black-colored bags, and 1.3% use brown biohazard bags for segregating Infectious waste. Also, 34.2% of the health facilities in Lagos state use red-colored bags, 36.9% use yellow-colored bags, 11% use black-colored bags, and 4.1% use brown-colored bags to segregate their hazardous waste. Conclusion: Some healthcare facilities in Lagos State do not follow the recommended guidelines for medical waste segregation. Waste generated is not appropriately segregated at the point of origin into the recommended colored bags/bins in some facilities. Thus, a policy and procedure regulating healthcare waste are mandatory. It is important to regularly train healthcare workers on proper waste management practices and encourage staff to read and apply WHO rules in managing healthcare waste. Healthcare personnel should realize that hazardous material is a potential cause of a public disaster.

Healthcare waste management in selected government and private hospitals in Southeast Nigeria

Objective:To assess healthcare workers' involvement in healthcare waste management in public and private hospitals.Methods:Validated questionnaires(n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013.Results:Among the healthcare workers that participated in the study,187(28.33%) were medical doctors,44(6.67%) were pharmacists,77(11.67%) were medical laboratory scientist,35(5.30%) were waste handlers and 317(48.03%) were nurses.Generally,the number of workers that have heard about healthcare waste disposal system was above average 424(69.5%).More health-workers in the government(81.5%) than in private(57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it.The level of waste generated by the two hospitals differed significantly(P=0.0086) with the generation level higher in government than private hospitals.The materials for healthcare waste disposal were significantly more available(P=0.001) in government than private hospitals.There was no significant difference(P = 0.285) in syringes and needles disposal practices in the two hospitals and they were exposed to equal risks(P =0.8510).Fifty-six(18.5%) and 140(45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste management committee with 134(44.4%) and 19(6.2%) workers confirming that it did not exist in their institutions.The existence of the committee was very low in the private hospitals.Conclusions:The availability of material for waste segregation at point of generation,compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.

Estimation of Different Categories of Healthcare Waste Generated at Two Different Hospital Categories in Four Hospitals in Dar es Salaam City

This study aims to estimate the quantity of healthcare waste categorically generated in four different healthcare in Dar es Salaam city namely, Muhimbili National Hospital, Mwananyamala Regional Referral Hospital, Temeke Regional Referral Hospital and Ilala Regional Referral Hospital to evaluate the quantities of medical waste generated based on their level and capacity. Waste was collected in different categories of non-infectious, sharps, infectious, infectious plastics, and pathological waste which were measured daily for fourteen (14) consecutive days in all hospitals by using a weighting scale and observational checklist to document related waste management information and the assessment of the healthcare waste generation in each hospital. The average general healthcare waste generation rate per healthcare ranges from 298.9 kg/day to 1554.4 kg/day. The high fluctuation in general medical waste was established to be attributed to specialization difference between one hospital to the other, and the large number of in-patients and out patients between hospitals. The overall average sharps waste generation rate was established to range from 8.5 ± 2.7 - 13.9 ± 1.8 kg/day. Higher values of sharps waste generated observed at Muhimbili hospital are due to emergency cases referred to from other hospitals located within the city and from the surrounding districts and other regions of the country. The results from this study, raise alarm to hospital administrators, and other health stakeholders working in related fields to give special attention and priority in setting a related share in their budgets for proper management of medical waste in their health facilities.

Assessment of Medical Waste Management in El Shifa and Al Aqsa Hospitals-Gaza Strip

Medical waste management is of great importance due to its infectious and hazardous nature and its management is not fully understood. This study examined the medical waste management practices in two large hospitals (El Shifa and Al Aqsa hospitals) in Gaza strip. The study used face to face questionnaire, workshops, interviews to managers and field observations for data collection. Results showed that both hospitals did not quantify medical wastes but medical wastes were separated in each department. Field observation indicated that medical waste separation into infectious medical waste and non-infectious medical waste was not conducted according to WHO (World Health Organization) standards or any specific standards. Medical wastes were transported from each department to waste container inside the hospital then moved to the storage area or municipal container. Medical waste employees (n = 51;66.2%) revealed that medical wastes are stored temporarily in the hospital in a not suitable place in terms of ventilation, lighting and easy access. Furthermore, occupational safety among employees was not fully implemented, as large percentage of them (n = 48, 94.1%) revealed that the used protective clothes during work were not fully effective. Furthermore, incineration was the main treatment of infectious medical waste whereas, non-infectious wastes were disposed in landfills. Additionally, both hospitals did not provide any training for employees regarding medical waste management. In conclusion, medical waste management is far below WHO standards in both hospitals. It is recommended to provide training courses to the employees to improve the quality of environmental health and reduce health hazards in the hospitals.

Going toward Green Hospital by Sustainable Healthcare Waste Management: Segregation, Treatment and Safe Disposal

Hospitals have always been the focal point of social systems identity. Thus, they acte as the mirror of the community and should be responsible for it. Hospitals have been recognized as a significant source of contamination all around the world, therefore helping to endanger public health on an unintentional process. Although, the main mission of the hospital is to promote human health, it cannot be assumed as an island apart from its urban environment. “Green Hospital”, as an approach to address environmental challenges and to meet communities need in health issues, has emerged recently as a try to improve the health, in line with its main mission. In this approach, all the environmental aspects of waste management are important and to be addressed. Hospitals’ administrators can manage wastes disposal through composting, recycling and better supplying methods (downsizing packaging, using reusable products instead of disposables and using recycled products). This article is a review of the subject matter, in nature, using many library and online sources;it discusses about the need to move towards the green hospital approach, the administration and leadership role in its establishment, the environmental impact of hospital operations and assessment of the effects, wastes management and control, and also the methods in wastes disposal and treatment.

Assessing Biomedical Solid and Liquid Waste Management in University Hospital Centers (CHU) in Togo, 2021

Introduction. Biomedical waste represents an environmental concern and a risk to healthcare workers, users of healthcare services, and the surrounding population. This study aimed to assess the management of solid and liquid biomedical waste in University Hospitals Centers (UHC) in Togo in 2021. Methods. This is a cross-sectional, evaluative and analytical study undertaken in 2021. It involved 3 UHCs, 25 departments, 340 care providers and departments randomly selected, 72 directors or deputies, supervisors and heads of departments, 27 collection and incineration agents selected by a reasoned choice technique, and 44 patients and attendants selected by an accidental choice technique. Data analysis was done using Pearson’s Chi2 statistical test for comparing proportions and logistic regression. Results. Solid and liquid waste management was “poor” due to non-use of waste management guidelines (ORa = 3.50;p = 0.0000), insufficient training of healthcare providers and collection agents (ORa = 6.55;p = 0.0000 and ORa = 6.08;p = 0.0000 respectively), insufficient user awareness sessions (ORa = 4.04;p = 0.0001), insufficient coordination of activities (ORa = 5.07;p = 0.0002), insufficient supervision of service providers and collection agents (ORa = 2.34;p = 0.0000), insufficient monitoring and follow-up of activities (ORa = 20.40;p = 0.0000). The sorting was not systematic (74.1%), and the Biochemical Oxygen Demand (BOD) and Chemical Oxygen Demand (COD) of the effluents were relatively high. Conclusion. Managing solid and liquid biomedical waste is insufficient in Togo’s university hospitals and represents a potential risk to human health and the environment.

Re-Use of Hospital Plastic Waste in Asphalt Mixes as Partial Replacement of Coarse Aggregate

About 1.3 billion tons of waste is being generated in the world annually. This waste is a cause of various diseases. Open dumping of waste also destroys valuable agricultural land. Various researchers have beneficially used plastic waste in cement concrete and asphalt concrete in the past. This study aims at the use of aggregates, made from different types of plastic waste, as partial replacement of coarse aggregates in asphalt mixes. For this purpose waste is collected from different hospitals of the city. Sorted plastic from the waste consists of 64% low density polyethene, 32% high density polyethene and 4% of polypropylene. Plastic waste is shredded, heated and after cooling, pulverizes manually and mechanically. Specific gravity of plastic aggregates is 0.96. Water absorption and soundness values are 4.68% and 7.68% respectively. Impact, crushing and Loss Angeles values of plastic aggregates are 0.7%, 0.5%, and 1.1% respectively. Replacement of natural aggregates by plastic aggregates in asphalt mixes is done up to 25% with 5% incremental increase. Density of asphalt mixes decreases to 2060 kg/m3. Consequently flow increases to 5.73 mm. Maximum stability is at 20% replacement i.e. 34.57 KN. Cost analysis of the study indicates that 205% increase in stability are observed with 219% increase in cost.

智能垃圾被服收集系统在精神专科医院的应用探索

针对精神专科医院科室设置及医疗流程等与综合性医院存在差异化情况,以及各项管理政策的要求,设计符合上海市精神卫生中心实际需求且具有高效、安全、建筑适配度高等优势的垃圾被服收集系统,为有效简化医院垃圾被服收集流程、提升医院感控水平、营造更为良好的就医环境提供必要的保障。

Hospital Acquired Infections in Low and Middle Income Countries: Root Cause Analysis and the Development of Infection Control Practices in Bangladesh

Nosocomial or hospital acquired infections are a major challenge for low and middle income countries (LMICs) which have limited healthcare resources. Risk factors include the lack of appropriate hospital facilities such as isolation units, bed space, and sinks;inadequate waste management, contaminated equipment, inappropriate use of antibiotics and transmission of infection from the hands of healthcare workers and family caretakers due to inadequate hand washing. Nosocomial infections increase the costs of healthcare due to added antimicrobial treatment and prolonged hospitalization. Since the prevalence of nosocomial infections is generally higher in developing countries with limited resources, the socio-economic burden is even more severe in these countries. This review summarizes the current knowledge on the risks of hospital acquired infections and summarizes current recommendations for the development of hospital infrastructure and the institution of protocols to reduce these infections in LMICs such as Bangladesh.

Usefulness of a Simple Protein-Energy Wasting Score for Predicting Hospitalization in Maintenance Hemodialysis Patients: A Prospective Cohort Study

Background: Malnutrition is a strong predictor of prognosis in maintenance hemodialysis patients (MHD). We previously proposed a new and simple protein-energy wasting (PEW) score that appears to be useful for assessing the risk of mortality in patients on MHD. Objectives: In the present study, we evaluated the reliability of this PEW score as a predictor of hospitalization in Japanese patients on MHD. Methods: In this single-center, prospective cohort study conducted in Japan, PEW score was calculated for 180 MHD patients. PEW score ranged from 0 (best: S1) to 4 (worst: S4) and was calculated based on nutritional indicators including serum albumin, body mass index, serum creatinine level, and protein intake. The outcome was the number of hospitalizations during the 2-year study period. Results: Thirty-six patients were hospitalized during the study period. Kaplan-Meier curves showed there were fewer hospitalizations in the group with a PEW score of 0/1 than in the group with a score of 3/4. Multivariate analysis revealed a hazard ratio for hospitalization of 3.109 for S3/4 versus S0, 2.777 for S3/4 versus S1, and 2.048 for S3/4 versus S2. Conclusion: The new and simple PEW score is a useful predictor of hospitalization in MHD patients and is also useful for identifying subgroups of MHD patients with a high risk of mortality.

Hospital Hygiene Maternity Hospital Public Lubumbashi Democratic Republic of Congo

Introduction: Public hospitals in the DRC are of significant disrepair, while there is a strong link between the failure of hospital hygiene and the incidence of nosocomial infections. We have conducted a study with the objective of evaluating the structural-functional conditions of hospital hygiene maternity wards of public hospitals in Lubumbashi. Methodology: It was a descriptive cross-sectional study and structural-functionalist whose population consisted of nurses responsible for 7 of 12 maternity hospitals which were selected based on the inclusion criteria. The observation with an observation guide and maintenance using a questionnaire we used to collect data. Results: The results showed that hospital hygiene conditions in maternity wards of public hospitals in Lubumbashi are not good because almost all maternity services and surgery are not always water in the taps (14.3%). The bins were a means for care units, no coding system exists to distinguish the type of waste. The medical waste are mixed and the other waste are burned in the open or in makeshift incinerator with other types of waste. Conclusion: These maternity wards have poor hygiene, staff responsible for this sector did not follow any training in this area. There is need to regulate the sector and train them.

医院废物管理中的PDCA循环法应用分析

目的:研究医院的医疗废物管理策略,强化管理规范性与制度性。方法:根据PDCA法流程,借助检查活动确定废物管理中的问题,并对问题形成原因进行分析,制定相关管理制度,组织医务人员开展培训工作,并进行交叉检查,根据反馈资料再次展开优化处理。对使用PDCA法之前与之后医务人员在废物管理方面的情况进行调查和统计分析,并对实施效果进行评价。结果:2019年1月-2020年6月,该医院医务人员在医疗废物管理相关知识的认识方面有效提升,由55.59%上升至94.44%,差异具备统计学意义(P<0.001)。期间各个科室的废弃物交接准确率由68.91%上升至94.91%,其差异具备统计学意义(P<0.001)。结论:PDCA循环法管理提高了该院医疗废物交接登记的准确性,实现了医疗废物可追溯的闭环监管,充分提高了废物处置各个环节的合格率。

浅谈医院污水处理站及改进建议

污水处理站是医院必备的基建设施,污水处理及监测是医院必不可少的一项工作,相对于生活污水,医院污水包含过多的化学试剂、病毒细胞、寄生虫、病原体、废气臭气甚至放射性污染物等,因此医院污水消毒处理的关键性不言而喻。本文以某医院MBR技术+二氧化氯消毒工艺处理医院污水,并以UV光解工艺处理废气为例,对此工艺进行效果分析。监测结果表明,该工艺可行,运行效果稳定,经过此工艺处理的污水废气完全符合国家污水废气排放标准。

医院放射科余热回收设计与实践

本文针对某医院放射科CT、MRI等设备的大型室外机放置在停车场负二层,造成的余热浪费和停车场局部高温问题,结合医院实际情况设计了一种余热回收方案,通过在停车场负二层安装空气源热泵热水机组的方式,利用余热补充供应医院的生活热水,实现了对大型医疗设备室外机产生余热的回收利用。同时,以医院放射科为例,探索了余热回收的新型方案和实践,以及对回收方案的经济效益进行估算,发现空气源热泵热水机组运用于室内余热回收具有优越性,值得在类似环境进一步推广与应用。

旧改医院与新建医院工程在功能设置及实现方式上的差异——以深圳平乐骨伤科医院项目为例

以深圳平乐骨伤科医院项目为研究对象,阐述了该项目面临的各种难题,分析了既有建筑改造而成的医院(以下简称“旧改医院”)与新建医院在功能设置及实现方式上的差异,总结医院在功能设置上的重点,并提出功能完善的意见及解决方案,以期为旧改医院工程提供参考。

两种医疗垃圾焚烧炉的灰渣特性研究

为评价医疗垃圾焚烧灰渣对环境的危害性及寻找安全有效的处理方法,利用X-射线荧光光谱仪、X射线衍射仪、扫描电镜、原子吸收光谱仪等仪器分别对回转窑式、固定床式医疗垃圾焚烧炉的布袋飞灰及底渣进行化学成分、物相、微观形貌、重金属含量及渗沥行为等特性分析.结果发现,回转窑式和固定床式布袋飞灰热灼减率分别为31.2%、34.6%,两者Cl、SO3和碱金属含量均较高,主要物相为CaSO4和NaCl,且Cd、Zn、Pb等重金属渗沥浓度均超过危险废物填埋允许限值,其渗沥行为可能与布袋飞灰的不规则多孔海绵状微观形貌有一定关系;2种底渣主要由复杂硅酸盐构成,其渗沥浓度低于危险废物规定的阈值.因此,2种布袋飞灰经预处理后方能进入危废填埋场填埋,2种底渣可按一般工业固废直接填埋.

长沙市医疗垃圾处置现状

目的了解长沙市医疗垃圾的管理状况。方法选择长沙市3所综合性医院、1所肿瘤专科和1所儿科专科医院调查医疗垃圾的种类、产量、收集和处理。结果医疗垃圾的主要成分是玻璃、塑料和棉纱 ,分别占55%、20%和12%。3所综合性医院的医疗垃圾日产量分别为0.48、0.63、0.43kg/床 ,儿科和肿瘤专科医院医疗垃圾日产量分别为0.58和0.74kg/床。据此估算长沙市日产医疗垃圾9.390t。医疗垃圾回收率为49.32 % (其中主要是玻璃和塑料 ) ,处理率仅1.34% ,还有49.34%混入生活垃圾或掩埋。结论长沙市医疗垃圾管理仍不完善 。