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PubMed1999

High-quality filtration allows reuse of anesthesia breathing circuits resulting in cost savings and reduced medical waste.

STUDY OBJECTIVES: To determine if the new Filta-Therm filter prevents contamination and allows the reuse of breathing circuit with considerable cost and environmental savings. DESIGN: Prospective study. PATIENTS: 52 ASA physical status I, II, III, and IV patients, aged 18 to 75 years. INTERVENTIONS: Each morning a new breathing circuit was assembled. The Filta-Therm filter (Intersurgical, Inc., Liverpool, NY) elbow, and mask, but not the circuit, were changed between patients. The filter was placed between the Y-piece and the elbow of the breathing circuit. Prior to anesthesia, samples were obtained at the Y-piece, and the inspiratory and expiratory ports of breathing circuit. Following anesthesia, samples were obtained at the Murphy eye of endotrachael tube, and at the Y-piece. The samples were incubated, and the results examined at 24 and 48 hours. MEASUREMENTS AND MAIN RESULTS: Prior to anesthesia, cultures of the Y-piece and the inspired and expired ports samples showed no growth. Following anesthesia, all 52 samples obtained at the endotracheal tube were contaminated with various organisms, while all 52 Y-piece samples showed negative growth. CONCLUSIONS: The single use of Filta-Therm filter prevents bacterial contamination and allows reuse of breathing circuit at least twice, resulting in significant cost savings ($50,778 per year). Further studies are needed to establish the safety of reusing breathing circuits when appropriate bacterial filters are used.

Adolescent↗
PubMed2002

Microbial, chemical and physical aspects of citrus waste composting.

Citrus waste supplemented with calcium hydroxide and with a C/N ratio of 24:1, pH of 6.3 and moisture content of 60% was composted by piling under shelter. With regular turning over of the pile and replenishment of moisture, the thermic phase lasted for 65-70 days and composting was completed after 3 months. Compost thus prepared had an air-filled porosity of 14%, water-holding capacity of 590 ml l(-1), bulk density of 1.05 g cm(-3) and conductivity of 480 mS m(-1). Phosphorus content (in mg l(-1)) was 15, potassium 1,170, calcium 362, magnesium 121, sodium 32, chloride 143, boron 0.31, and water-soluble nitrogen and organic matter 126 and 4788, respectively. Total carbon amounted to 8.85% and total nitrogen to 1.26% of the dry weight, giving a C/N ratio of 7. Mature compost showed some, but acceptable, levels of phytotoxicity. Raw citrus waste was predominantly colonised by mesophilic yeasts. Thermophilous microorganisms present during the thermic phase mainly comprised the bacterial species Bacillus licheniformis, B. macerans and B. stearothermophilus and, to a lesser extent, fungi such as Absidia corymbifera, Aspergillus fumigatus, Emericella nidulans, Penicillium diversum, Paecilomyces variotii, Rhizomucor pusillus, Talaromyces thermophilus and Thermomyces lanuginosus. Bacteria prevalent in the final product included B. licheniformis, B. macerans, Proteus vulgaris, Pseudomonas aeruginosa, P. fluorescens, P. luteola and Serratia marcescens, whereas fungi isolated most frequently comprised Aspergillus puniceus, A. ustus, E. nidulans. Paecilomyces lilacinus, T lanuginosus, yeasts and a basidiomycetous species, probably Coprinus lagopus.

Calcium Hydroxide↗
PubMed2003

Immunization safety priority project at the World Health Organization.

In 1999, the World Health Organization's (WHO) Department of Vaccines and Biologicals launched the Immunization Safety Priority Project with the aim of establishing a comprehensive system to ensure the safety of all immunizations given in national immunization programs. Countries are the primary focus of the project. WHO has a role, not only because of its technical and normative role, but also because of its privileged relationship with country authorities and other partners, and its global vision and mandate. The four major areas of focus in the project are to (1) promote and coordinate research and development of safer and simpler delivery systems; (2) ensure vaccine safety, from vaccine development all the way through clinical trials and vaccine distribution until use; (3) broaden access to safer and more efficient systems for vaccine delivery and management of sharps waste; and (4) establish efficient mechanisms to detect serious or potentially serious adverse events following immunization, and enable prompt and effective response. The project emphasizes the importance of advocating safety and building capacity at national levels.

Advisory Committees↗
PubMed2001

[Prospective study of the causes for destruction of labile blood products during 1999 at a University Hospital Center].

The destruction of the blood cell product (BCP) is a situation which is hard to accept in the present context of transfusional safety which aims at covering the transfusional needs in the most appropriate way. In our University Hospital, 500 BCP out of 20,000 are destroyed per year, which represent a cost of 100,000 $. A prospective research was carried out from January 1st to December 31st 1999 in order to analyse the causes of the destruction of the BCP and to differentiate the inevitable destructions for the patient's security from the avoidable destructions which might have benefited from corrective measures. For each group of simultaneously destroyed BCP, an information note specified the patient's pathology, the reasons for the prescription, the number and the type of transfused and destroyed BCP in the same day, the time spent between distribution and return, and the causes of destruction. In 1999, a total of 483 LBP out of 19,802 which were distributed, have been returned and destroyed, that is to say 2.4% for a 99.3% traceability which involved 242 patients. Among these destroyed BCP, 28.3% came from inevitable causes--death or acute intensive care which needed a lot of transfusions--69.7% were categorised as being related to avoidable causes depending on the organisation of transport and care, unadapted safety measures. The corrective measures to be taken, concern the improvement of transport procedures, the set-up of a nominative BCP reservation system in the Blood Center, the scheduling of the BCP deliveries from the blood bank, and a better adaptation of the safety measures to the transfusional needs.

Blood Banks↗
PubMed2004

Trace determination of macrolide and sulfonamide antimicrobials, a human sulfonamide metabolite, and trimethoprim in wastewater using liquid chromatography coupled to electrospray tandem mass spectrometry.

An analytical method has been developed and validated for the simultaneous trace determination of four macrolide antibiotics, six sulfonamides, the human metabolite N4-acetylsulfamethoxazole, and trimethoprim in wastewater. The method was validated for tertiary, secondary, and-unlike in previously published methods-also for primary effluents of municipal wastewater treatment plants. This wide range of application is necessary to thoroughly investigate the occurrence and fate of chemicals in wastewater treatment. Wastewater samples were enriched by solid-phase extraction, followed by reversed-phase liquid chromatography coupled to tandem mass spectrometry using positive electrospray ionization. Recoveries from all sample matrixes were generally above 80%, and the combined measurement uncertainty varied between 2 and 18%. Concentrations measured in tertiary effluents ranged between 10 ng/L for roxithromycin and 423 ng/L for sulfamethoxazole. Corresponding levels in primary effluents varied from 22 to 1450 ng/L, respectively. Trace amounts of these emerging contaminants reach ambient waters, since all analytes were not fully eliminated during conventional activated sludge treatment followed by sand filtration. In the case of sulfamethoxazole, the amount present as human metabolite N4-acetylsulfamethoxazole had to be taken into account in order to correctly assess the fate of sulfamethoxazole in wastewater treatment.

Macrolides↗
PubMedDate not supplied

Heat inactivation of mammalian cell cultures for biowaste kill system design.

A biowaste kill system was implemented to treat biological waste generated from a clinical manufacturing and R&D antibody facility. To confirm that design parameters of this continuous decontamination system are sufficient to inactivate mammalian cell culture waste, bench-scale experiments were conducted. The biowaste kill system heat inactivates mammalian cell cultures before they are piped to a neutralization tank and subsequently released to the sewage system. Heat inactivation of cells is accomplished by exposing cells to 80 degrees C for 1 min. Small-scale heat inactivation studies were performed on CHO, 293-HEK, and hybridoma cells. Cells at 1 x 10(6) cells/mL or 1 x 10(7) cells/mL were exposed to 37, 60, 70, or 80 degrees C for 0, 30, 60, and 120 s. Viability based on trypan blue exclusion method and ability to proliferate was assessed after exposure to heat. Data suggest that exposure of cells to 80 degrees C for 60 s is sufficient to inactivate these cultures before they are released to the sewage system.

Animals↗
PubMed2003

Incineration of different types of medical wastes: emission factors for particulate matter and heavy metals.

Previously published results for emission factors of medical waste incineration do not include enough information about the incinerated waste composition. This paper reports the first emission factors estimated for particulate matter, As, Cd, Cr, Pb, Mn, Hg, and Ni, considering that medical waste is segregated in different types according to Portuguese legislation. The main purpose was to evaluate the influence of incinerated waste composition and segregation practice on emission factors. One "controlled-air" incinerator without air pollution control devices was used for the incineration either of mixtures with a defined composition or of a specific waste type. Previously published emission factors are not associated with the composition of the incinerated mixture, and the results showed that the usefulness of those emission factors is very doubtful. The existence of different waste classifications also reduces the usefulness of previously published results. To protect human health, appropriate equipment to control atmospheric pollutants must be used, since the legal limits for pollutant concentrations were strongly surpassed (226 times higher than the limit for Hg), with risks for patients and workers of the hospital and exposed population. It was concluded that rigorous segregation practices and adequate management methodologies allow reducing 80% of the amount of wastes that must be incinerated, practically eliminating Hg and Pb emissions and reducing those of PM, As, Cd, Cr, Mn, and Ni, respectively, 98, 90, 92, 84, 77, and 92%.

Air Pollutants↗
PubMed2004

Source identification of PCDD/Fs for various atmospheric environments in a highly industrialized city.

This study set out to identify possible PCDD/F emission sources for different atmospheric environments in a highly industrialized city located in southern Taiwan. We collected stack flue gas samples from five main stationary emission sources of the municipal solid waste incinerators (MSWIs), medical waste incinerators (MWIs), electric arc furnaces (EAFs), secondary aluminum smelters (ALSs), and sinter plants to assess the characteristics of their PCDD/F emissions. For mobile sources, congener profiles reported in U.S. EPA's database for unleaded gas-fueled vehicles (UGFV) and diesel-fueled vehicles (DFV) were directly adopted owing to lack of local data. The congener profiles of the 2,3,7,8-substituted PCDD/Fs were selected as the signatures of these PCDD/F emission sources. We conducted PCDD/F samplings on atmospheric environments of four categories, including background, residential area, traffic area, and industrial area. Through PCA and cluster analyses, we found that traffic areas were most influenced by PCDD/F emissions from UGFV and DFV, while those of industrial areas were mainly influenced by metallurgical facilities and MWIs. The above results were further examined by using the methodology of the indicatory PCDD/Fs. We confirmed that traffic areas were contributed by traffic sources, but industrial areas were simply affected by metallurgical facilities rather than MWIs. In conclusion, besides the use of PCA and cluster analyses, the methodology of the indicatory PCDD/Fs should be conducted for further validation in order to prevent misjudgment.

Air Pollutants↗
PubMed2006

Investigation of novel incineration technology for hospital waste.

Conventional incineration systems for hospital waste (HW) emit large amounts of particulate matter (PM) and heavy metals, as well as dioxins, due to the large excess air ratio. Additionally, the final process residues--bottom and fly ashes containing high levels of heavy metals and dioxins--also constitute a serious environmental problem. These issues faced by HW incineration processes are very similar to those confronted by conventional municipal solid waste (MSW) incinerators. In our previous work, we developed a novel technology integrating drying, pyrolysis, gasification, combustion, and ash vitrification (DPGCV) in one step, which successfully solved these issues in MSW incineration. In this study, many experiments are carried out to investigate the feasibility of employing the DPGCV technology to solve the issues faced by HW incineration processes, although there was no MSW incinerator used as a HW incinerator till now. Experiments were conducted in an industrial HW incineration plant with a capacity of 24 tons per day (TPD), located in Zhenzhou, Henan Province. Results illustrated that this DPGCV technology successfully solved these issues as confronted by the conventional HW incinerators and achieved the expected results for HW incineration as it did for MSW incineration. The outstanding performance of this DPGCV technology is due to the fact that the primary chamber acted as both gasifier for organic matter and vitrifying reactor for ashes, and the secondary chamber acted as a gas combustor.

Dioxins↗
PubMed2000

Waste, ownership and bodily products.

This paper considers the extent to which bodily parts and products can be legitimately regarded as "waste" in law and what are the legal consequences of regarding them in this manner. First, what is the approach of English law to bodily parts as property? Secondly, why is this an important legal issue? Thirdly, what do we mean when we say that something is "waste" and can bodily products/parts be classified as "waste"? Fourthly, if the English courts are prepared to recognise bodily parts and products as property, then what are the legal consequences of regarding bodily products as "waste" and what problems may arise from such a legal conceptualization? It is argued that these issues require a more measured considered approach to regulation than simply leaving them to ad hoc determination in the courts.

Bioethics↗
PubMed2002

Infection control: preventing iatrogenic transmission of spongiform encephalopathy in Danish hospitals.

The Danish infection control guidelines dealing with transmissible spongiform encephalopathy (TSE) recognise that preventive measures to avoid iatrogenic transmission must be taken, though the risk for patients in Danish hospitals can be characterised as minimal. A minimal risk situation cannot meanwhile be maintained unless hospitals and other healthcare institutions are prepared and have effective and well-functioning decontamination procedures in place suited for the purpose. The guidelines recommend that staff both in the operating theatre and in the Central Sterile Supply Department (CSSD) must be able to apply the procedures needed for safe handling and decontamination of used instruments. These include cleaning and effective sterilisation, as well as quarantine procedures and ways to discard and incinerate certain used instruments. The guidelines also address occupational safety, and single-use instruments are recommended where these are available and can be safely used. Effective procedures for decontamination of instruments and other medical devices are identified as the key to prevention of iatrogenic spread of TSE. Hospitals are advised to have their sterilisers and other equipment professionally checked in order to make sure that specific procedures for safe handling and decontamination of used surgical instruments and other medical equipment are available in case of suspected or confirmed TSE.

Decontamination↗