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PubMed1998

An investigation of the disposal of dental clinical waste in Bangkok.

This study investigated the disposal of clinical waste within dental surgeries in Bangkok, Thailand and followed the waste trail to the rubbish tips. A questionnaire was sent to all dental practices in the Bangkok Metropolitan Area. The response rate was 57.7 per cent. At the same time, rubbish collectors and scavengers were interviewed to see if they encountered clinical dental waste. Few dentists complied with all recommendations for the disposal of waste. Most waste was disposed of into the domestic rubbish stream. Rubbish collectors and scavengers knew what dental rubbish looked like and some had had needle-stick injuries. Although recommendations can be made to the dental profession to alter their behaviour, real improvement is unlikely without changes to legislation and social policy.

Attitude of Health Personnel↗

PubMed1999

Practical methods for reducing radioactive contamination incidents in the nuclear cardiology laboratory.

OBJECTIVE: The purpose of this study was to determine the extent and cause of radioactive contamination in our nuclear cardiology laboratory, and to develop possible solutions to minimize future occurrence. METHODS: We conducted a retrospective review to determine the underlying causes of the 15 minor radioactive contamination events that have occurred in the exercise areas of our laboratory since 1986. Of the 15 documented events, 8 were caused by failure of intravenous apparatus and 7 were due to syringe mishandling. Based on a staff questionnaire, we determined the most prevalent causes of radioactive contamination. Other than problems associated with intravenous setup, the causes were lack of experience by the individual performing the injection, followed closely by radioactive syringe disposal problems, injection technique, and unclear designation of duties during the exercise procedure. RESULTS: Based on these findings, we formulated a 4-part plan: a training program; a closely inspected intravenous apparatus; a mobile radioactive waste container; and a clear designation of duties for personnel to be included in the exercise procedure protocol. CONCLUSION: We have implemented a sensible and practical plan for reducing radioactive contamination, which is currently being evaluated.

Accidents, Occupational↗

PubMed2000

Applying environmental product design to biomedical products research.

The principal themes for the Biomedical Research and the Environment Conference Committee on Environmental Economics in Biomedical Research include the following: healthcare delivery companies and biomedical research organizations, both nonprofit and for-profit, need to improve their environmental performance; suppliers of healthcare products will be called upon to support this need; and improving the environmental profile of healthcare products begins in research and development (R&D). The committee report begins with requirements from regulatory authorities (e.g., U.S. Environmental Protection Agency [EPA], the U.S. Food and Drug Administration), and the healthcare delivery sector). The 1998 American Hospital Association and EPA Memorandum of Understanding to reduce solid waste and mercury from healthcare facilities is emblematic of these requirements. The dominant message from the requirements discussion is to ensure that R&D organizations do not ignore customer, environmental, and regulatory requirements in the early stages of product development. Several representatives from healthcare products manufacturers presented their companies' approaches to meeting these requirements. They reported on efforts to ensure that their R&D processes are sensitive to the environmental consequences from manufacturing, distributing, using, and disposing of healthcare products. These reports describe representatives' awareness of requirements and the unique approaches their R&D organizations have taken to meet these requirements. All representatives reported that their R&D organizations have embraced environmental product design because it avoids the potential of returning products to R&D to improve the environmental profile. Additionally, several reports detailed cost savings, sustainability benefits, and improvements in environmental manufacturing or redesign, and increased customer satisfaction. Many companies in healthcare delivery are working to improve environmental performance. Fundamental to these efforts is the necessity of motivating suppliers to improve the environmental profile of new products used in the healthcare delivery sector.

Biomedical Technology↗

PubMed2006

Mass fatality management following the South Asian tsunami disaster: case studies in Thailand, Indonesia, and Sri Lanka.

BACKGROUND: Following natural disasters, mismanagement of the dead has consequences for the psychological well-being of survivors. However, no technical guidelines currently exist for managing mass fatalities following large natural disasters. Existing methods of mass fatality management are not directly transferable as they are designed for transport accidents and acts of terrorism. Furthermore, no information is currently available about post-disaster management of the dead following previous large natural disasters. METHODS AND FINDINGS: After the tsunami disaster on 26 December 2004, we conducted three descriptive case studies to systematically document how the dead were managed in Thailand, Indonesia, and Sri Lanka. We considered the following parameters: body recovery and storage, identification, disposal of human remains, and health risks from dead bodies. We used participant observations as members of post-tsunami response teams, conducted semi-structured interviews with key informants, and collected information from published and unpublished documents. Refrigeration for preserving human remains was not available soon enough after the disaster, necessitating the use of other methods such as dry ice or temporary burial. No country had sufficient forensic capacity to identify thousands of victims. Rapid decomposition made visual identification almost impossible after 24-48 h. In Thailand, most forensic identification was made using dental and fingerprint data. Few victims were identified from DNA. Lack of national or local mass fatality plans further limited the quality and timeliness of response, a problem which was exacerbated by the absence of practical field guidelines or an international agency providing technical support. CONCLUSIONS: Emergency response should not add to the distress of affected communities by inappropriately disposing of the victims. The rights of survivors to see their dead treated with dignity and respect requires practical guidelines and technical support. Mass fatality management following natural disasters needs to be informed by further field research and supported by a network of regional and international forensic institutes and agencies.

Disaster Planning↗

PubMed2006

Hospital waste management and toxicity evaluation: a case study.

Hospital waste management is an imperative environmental and public safety issue, due to the waste's infectious and hazardous character. This paper examines the existing waste strategy of a typical hospital in Greece with a bed capacity of 400-600. The segregation, collection, packaging, storage, transportation and disposal of waste were monitored and the observed problematic areas documented. The concentrations of BOD, COD and heavy metals were measured in the wastewater the hospital generated. The wastewater's toxicity was also investigated. During the study, omissions and negligence were observed at every stage of the waste management system, particularly with regard to the treatment of infectious waste. Inappropriate collection and transportation procedures for infectious waste, which jeopardized the safety of staff and patients, were recorded. However, inappropriate segregation practices were the dominant problem, which led to increased quantities of generated infectious waste and hence higher costs for their disposal. Infectious waste production was estimated using two different methods: one by weighing the incinerated waste (880 kg day(-1)) and the other by estimating the number of waste bags produced each day (650 kg day(-1)). Furthermore, measurements of the EC(50) parameter in wastewater samples revealed an increased toxicity in all samples. In addition, hazardous organic compounds were detected in wastewater samples using a gas chromatograph/mass spectrograph. Proposals recommending the application of a comprehensive hospital waste management system are presented that will ensure that any potential risks hospital wastes pose to public health and to the environment are minimized.

Aliivibrio fischeri↗

PubMed1993

Universal precautions--a critical review.

The route of HIV transmission are now well defined. For health care workers the major occupational risk is from parenteral exposure to infected blood or other body fluids. To prevent such exposures, it would be prudent for HCWs to assume that all patients are potentially infected and a set of precautions applicable universally be followed in contacts with all patients. The provisions of "Universal Precautions" apply to blood, CSF, genital secretions and all body fluids. It is essential that barrier protection and washing of hands be practiced, body fluids be handled with care, correct sterilization and disinfection procedures be followed and a suitable system of waste disposal be evolved. Although the Universal Precautions have been useful in abating some of the more extreme behavior associated with treating AIDS patients and in establishing a rational approach to infection control, some of the recommendations have not been found to be efficacious or cost effective. Preventive measures recommend on the basis of demonstrated efficacy and aimed at routes of exposure that represent true risk are needed. The risks for occupational infection with blood borne pathogens have been a source of concern for health care workers (HCWs) because of their frequent and often substantial exposure to patient blood and body fluids. HCWs have long been identified as a group "at risk" for occupationally acquired Hepatitis B infection. With the development of acquired immunodeficiency syndrome (AIDS) epidemic, both HCWs and policy makers have become increasingly concerned about occupational risk from blood borne infections.(ABSTRACT TRUNCATED AT 250 WORDS)

Gloves, Protective↗

PubMed2004

Mathematical-statistical models of generated hazardous hospital solid waste.

This research work was carried out under the assumption that wastes generated from hospitals in Irbid, Jordan were hazardous. The hazardous and non-hazardous wastes generated from the different divisions in the three hospitals under consideration were not separated during collection process. Three hospitals, Princess Basma hospital (public), Princess Bade'ah hospital (teaching), and Ibn Al-Nafis hospital (private) in Irbid were selected for this study. The research work took into account the amounts of solid waste accumulated from each division and also determined the total amount generated from each hospital. The generation rates were determined (kilogram per patient, per day; kilogram per bed, per day) for the three hospitals. These generation rates were compared with similar hospitals in Europe. The evaluation suggested that the current situation regarding the management of these wastes in the three studied hospitals needs revision as these hospitals do not follow methods of waste disposals that would reduce risk to human health and the environment practiced in developed countries. Statistical analysis was carried out to develop models for the prediction of the quantity of waste generated at each hospital (public, teaching, private). In these models number of patients, beds, and type of hospital were revealed to be significant factors on quantity of waste generated. Multiple regressions were also used to estimate the quantities of wastes generated from similar divisions in the three hospitals (surgery, internal diseases, and maternity).

Environmental Monitoring↗

PubMed1994

[Present situation in self-injection therapy with interferon-alpha for patients with renal cell carcinoma].

Interferon-alpha (IFN alpha) is often used for the treatment of renal cell carcinomas. The injections are frequently self-administered at home. To assess how this therapy was accepted by the patient we sent out a questionnaire. For the past 2 years until March 1993, this therapy was performed in our department on 52 patients, of whom 45 were selected for the study. All patients were informed of their disease and consented to the necessity of this treatment. Thirty-eight patients answered this questionnaire. Almost all patients injected this agent mainly by themselves. These findings suggested that they regarded this therapy as a strategy to be executed by themselves for the treatment of carcinoma. The main toxic symptoms in this therapy were asthenia, fever and loss of appetite. Leukocytopenia occurred in about half of the patients, of whom 1 patient required medication because of a rapid decrease in the white blood cell count shortly after inception of this therapy. The treatment was discontinued in 50% of the patients because of these adverse effects. Systemic toxicity disappeared after cessation of IFN alpha administration. Additionally, over 80% of the patients expressed concern about effectiveness, the duration and high cost of this therapy. The patients had to be repeatedly instructed about the method of disposing used needles and syringes. This study revealed that self injection of IFN alpha, which required strict management particularly at the initiation, can be performed at home. However, countermeasures must be taken against the side actions and an optimum regimen of IFN alpha should be established as soon as possible.

Adult↗

PubMed2002

Assessing cross infection prevention measures at the Dental Clinic, University College Hospital, Ibadan.

The dental clinic is an environment where disease transmission occurs easily. Prevention of cross infection in the dental clinic is therefore a crucial aspect of dental practice and dental clinic workers must adopt certain basic routines while practising. This study evaluates basic routines in prevention of cross-infection in the dental clinic, University College Hospital Ibadan. The sample comprised 77 dental clinic workers, who completed closed-ended questionnaires. The questionnaires enquired into practices of the workers in the clinic as well as in the laboratories Physical inspection of dental equipment, instruments and materials was also carried out. The results highlight poor compliance of workers, especially the dental surgeons and students, with the hepatitis B vaccination programme of the Hospital. History to identify high risk individuals was often overlooked and was practised by less than 50% of the clinic workers. Barrier technique with the exception of the use of eye shield, was well practised by all the clinic workers. Aseptic technique was well practised in the dental clinic. Inadequate number of dental surgery assistants, faulty sterilizing equipment, poor monitoring of sterilization, coupled with inadequate number of instruments contributed to the poor success of prevention of contamination and instrument processing procedures. Less than 30% of dental surgeons and fewer than 50% of students discarded sharp materials into the yellow/sharp bin. Liquid waste was well disposed off through the drain for onward flow into the sewer, whilst the disposal of solid contaminated waste did not conform to stipulated international standard. The study found that successful infection control in the dental clinic was highly dependent on the dental surgery assistants, because highly technological equipment were lacking. The management/administration also plays an important role in the number of physical and human resources available and in the overall surveillance of nosocomial infections.

Asepsis↗

PubMedDate not supplied

Zero-Stik-Safety Syringe: an automatic safety syringe.

Needlestick injury (NSI) is an important although rare cause of the transmission of blood-borne viruses to healthcare staff. Many NSIs are avoidable. The use of universal precautions and careful sharps disposal are key factors in the prevention of injury. The availability of safety devices is increasing as it is recognized that action is necessary to prevent NSI. Devices that are easy to use and require no extra effort on behalf of the healthcare worker are preferred. There is evidence that safety devices decrease the rate of NSI. Zero-Stik Safety Syringe, manufactured by New Medical Technology, automatically retracts the needle once the injection is complete. It is simple to use and requires no formal training.

Accidents, Occupational↗

PubMed2006

[Gravimetric characterization of potentially infectious material in urban solid waste in southern Belo Horizonte, Minas Gerais State, Brazil].

This study investigated potentially infectious waste (feces, urine, blood, body fluids) in the composition of total municipal solid waste. From August to September 2002, solid waste samples from southern Belo Horizonte, capital of the State of Minas Gerais, were collected and sent to the solid waste treatment and disposal site at BR-040 for segregation and quantification. Sharps (objects that can cause cuts or puncture wounds) made up 0.02+/-0.02% of the collected waste, while non-sharps accounted for 5.47+/-1.11%. In the sharps category, the majority were razor blades (0.01+/-0.01%), while among non-sharps the most frequent components were toilet paper (3.00+/-0.90%), diapers (2.21+/-1.08%), and sanitary napkins (0.22+/-0.12%). Household infectious waste was twice the total amount of waste (infectious + common) from healthcare units. The study was discussed in light of the health hazards and safety aspects for formal and informal waste collectors.

Brazil↗

PubMed1998

Disposal of therapeutic 131I waste using a multiple holding tank system.

Therapeutic application of 131I for the treatment of thyroid cancer generates a significant amount of liquid radioactive waste. Discharge of this waste into the public sewage system is governed by local regulations. In Canada, the permissible concentration is such that only a few patients can be treated in modern water-efficient buildings if this waste is discharged directly through the toilet to the public sewage system. If the toilet discharge is first collected into a holding tank for physical decay before it is released, a large patient load can be handled without exceeding the permissible concentration. In this paper, the principles of operation and the design parameters are discussed, and a multiple holding tank system installed in the Princess Margaret Hospital/Ontario Cancer Institute is described.

Equipment Design↗

PubMed1999

A decade of change in clinical waste treatment and disposal in Scotland.

Ten years ago there were over 150 small incinerators located on hospital premises throughout Scotland. The majority were operated by portering staff, had poor combustion and no gas cleaning equipment. At that time alternatives to incineration were in their infancy and relatively expensive. Funding for major capital projects lay with the Government, and a strategic study suggested the installation of 12 centralised modern incinerators on the mainland and three on the islands: one per Scottish Health Board. Some health boards proceeded with new installations well ahead of dead-lines for closure of old plant. Others adopted a 'wait and see' policy and were overtaken by political changes. These resulted in a cutback in government-funded capital investment and a shift of non-core services to the private sector. Clinical waste disposal was contracted out as a service contract and some private sector companies offered alternative low-temperature technologies for clinical waste treatment. As a result there is now the opportunity to compare the advantages and disadvantages of incineration, sterilization, dry heat disinfection and other techniques. Technological change has also required revised waste segregation methods within the hospitals. In parallel with this there has been an overall reduction in waste quantities. The remaining incinerator operators are now faced with more stringent emission limits to be implemented by June 2000. This is resulting in closures of incinerators that have been operating for a few years. The situation continues to change.

Data Collection↗

PubMed1999

Microbiological aspects of clinical waste.

It is a requirement that hospitals and other areas that generate clinical waste must comply with good practice and legislation regarding its disposal. To meet the stringent European emission standards enforced in October 1995, there is a need to find an alternative to local incineration for dealing with clinical waste. The options included technologies such as gasification, steam sterilization or heat disinfection which can be used to process certain categories of clinical waste prior to landfill--all have advantages and disadvantages. Segregation of clinical and domestic wastes in healthcare settings is important to avoid accidents and litigation and to contain costs. Evidence that most clinical waste (other than perhaps waste from patients with certain infections and sharps) is a significant hazard to the public is lacking. More still needs to be done in the area of clinical waste management to assess the real risks and hazards of this waste.

Humans↗

PubMed2003

Oxytocin in prefilled Uniject injection devices for managing third-stage labor in Indonesia.

We assessed the use and acceptability of an injection device (Uniject) prefilled with oxytocin, as part of active management of third-stage labor (AMTL) by Indonesian midwives attending home births. We interviewed 140 village midwives (bidan di desa) and 2220 mothers whose deliveries they attended during the intervention period. We completed baseline and post-intervention assessments to determine their experiences and views of oxytocin Uniject use. Delivery logs and supervisory reports were reviewed. The assessment was done in three rural districts and one municipality in Lombok. Injection practices and oxytocin availability did not change dramatically, although dose accuracy, use of sterile injection equipment, and proper disposal improved when the Uniject device was used. Midwives had little difficulty using the Uniject device properly; they overwhelmingly preferred it to standard needles and syringes. Postpartum hemorrhage rates did not change substantially. Oxytocin via Uniject holds promise for safer, more convenient use of oxytocin by trained midwives attending home deliveries, thereby potentially reducing the incidence of postpartum hemorrhage.

Attitude of Health Personnel↗

PubMedDate not supplied

Adherence to universal precautions among laboratory personnel in Lebanon.

To evaluate the present situation and plan future directions with regard to implementation of universal precautions in laboratories testing blood samples, we carried out a national cross sectional study in 2003 on a representative sample of laboratories in Lebanon. We compared the results with those of a 1993 study. We found that the education profile of staff had improved, being now more specialized in laboratory science. The discrepancies between what technicians knew, believed in and practised and what was observed in the field improved to some extent in most variables. Disposal of needles and syringes had improved greatly but disposal of blood-contaminated material had not. Given the risks of improper practice, a policy of universal precautions is essential and regular training should be carried out so that staff know and practise the universal precautions and correct laboratory procedures.

Attitude of Health Personnel↗

PubMed2001

Health-care waste management in India.

Health-care waste management in India is receiving greater attention due to recent regulations (the Biomedical Wastes (Management & Handling) Rules, 1998). The prevailing situation is analysed covering various issues like quantities and proportion of different constituents of wastes, handling, treatment and disposal methods in various health-care units (HCUs). The waste generation rate ranges between 0.5 and 2.0 kg bed-1 day-1. It is estimated that annually about 0.33 million tonnes of waste are generated in India. The solid waste from the hospitals consists of bandages, linen and other infectious waste (30-35%), plastics (7-10%), disposable syringes (0.3-0.5%), glass (3-5%) and other general wastes including food (40-45%). In general, the wastes are collected in a mixed form, transported and disposed of along with municipal solid wastes. At many places, authorities are failing to install appropriate systems for a variety of reasons, such as non-availability of appropriate technologies, inadequate financial resources and absence of professional training on waste management. Hazards associated with health-care waste management and shortcomings in the existing system are identified. The rules for management and handling of biomedical wastes are summarised, giving the categories of different wastes, suggested storage containers including colour-coding and treatment options. Existing and proposed systems of health-care waste management are described. A waste-management plan for health-care establishments is also proposed, which includes institutional arrangements, appropriate technologies, operational plans, financial management and the drawing up of appropriate staff training programmes.

Cities↗

PubMed2004

Donor blood procurement and utilisation at the University of Benin Teaching Hospital, Benin City.

Banked blood is a limited resource in Nigeria. We sought to evaluate factors that may further limit the effective utilisation of donor blood in a tertiary hospital in Benin City. The records of the blood transfusion unit of the hospital were studied to identify the methods of blood procurement and utilisation from January 1, 2000 to December 31, 2002. A total of 11,021 units of blood were received in the blood transfusion unit within this period out of which 1491 (13.5%) donor blood samples were found unfit for transfusion and, hence, discarded. Commercial blood donation accounted for 95.3%, compared to 4.7% from replacement and volunteer donors. Commercial blood donation was a major risk factor for likely disposal of donor blood (chi2 = 74.3, p < 0.0001, OR = 21.1. 95% CI = 7.8-56.7). Expired units of blood with low PCV were discarded for lack of infrastructure to fractionate and store them. Over 0.8million naira (US$6000.00) is wasted annually on discarded units of donor blood mainly from commercial donors. A policy on blood procurement to include subgroup selection of donors and improved funding of blood banking services may enhance efficient and effective utilisation of donor blood.

Blood Banks↗