Environment, wealth, inequality and the burden of disease in the Accra metropolitan area, Ghana

The study examines environmental problems and adverse impacts on the health of urban households in the Accra metropolitan area, Ghana. Accra is faced with severe inadequacy of urban infrastructure in the face of rapid population growth in the metropolis. More than half of the city's population do not have access to solid waste collection services. Only 39.8% of households have indoor pipe and over 35.0% of households depend on unsanitary public latrines whilst 2.5% do not have access to toilet facilities. Human excrement, garbage and wastewater are usually deposited in surface drains, open spaces and streams in poor neighbourhoods. The resultant poor sanitation has serious health impacts as more than half of reported diseases are related to poor environmental sanitation. The majority of households depend on solid fuels for cooking and this leads to indoor air pollution and high incidence of respiratory infections. Poor households bear a disproportionately large share of the burden of environmental health hazards than their wealthy counterparts, due to their particular vulnerability resulting from inadequate access to environmental health facilities and services.     

Home hygiene and environmental sanitation: a country situation analysis for India

Problems of the environment and of domestic hygiene are always related to poverty of population and the sanitation of settlements. Most cities and towns in developing countries, like India, are characterised by over-crowding, congestion, inadequate water supply and inadequate facilities of disposal of human excreta, waste water and solid wastes. Inadequacy of housing for most urban poor invariably leads to poor home hygiene. Personal and domestic hygiene practices cannot be improved without improving basic amenities, such as water supply, waste water disposal, solid waste management and the problems of human settlements. But even under the prevailing conditions, there is significant scope of improving hygiene practices at home to prevent infection and cross-infection. Unfortunately, in developing countries, public health concerns are usually raised on the institutional setting, such as municipal services, hospitals, environmental sanitation, etc. There is a reluctance to acknowledge the home as a setting of equal importance along with the public institutions in the chain of disease transmission in the community. Managers of home hygiene and community hygiene must act in unison to optimise return from efforts to promote public health. Current practices and perceptions of domestic and personal hygiene in Indian communities, the existing levels of environmental and peri-domestic sanitation and the 'health risk' these pose will be outlined, as well as the need for an integrated action for improving hygiene behaviour and access to safe water and sanitation.     

济南市城市生活垃圾综合治理对策的探讨

通过对国内外和济南市城市生活垃圾收运处置现状的调查研究分析，提出济南市城市生活垃圾综合治理对策，首先建立与市场经济相适应的管理体系，其次将垃圾治理的重点从最终处理转移至垃圾源头治理，实施垃圾分类收集，再次推进垃圾处理产业化进程，制定并实施垃圾处理的收费政策和有关的经济技术政策。     

Report of the Council on Scientific Affairs. Biohazardous waste management: what the physician needs to know. American Medical Association

Sources of biohazardous waste include not only large hospitals and laboratories, but also physicians' offices, dental offices, clinics, research facilities, surgery centers, veterinary offices, funeral homes, and a growing number of settings where home health care is delivered. State and local municipality definitions and regulations on biohazardous waste vary widely. Most regulations exempt home health care settings, but include physicians' offices. Although the infectious public health risk posed by medical waste is exceedingly low, this fact is not well understood by the general public. Physicians should develop biohazardous waste management programs that fulfill their county, state, and municipal regulations and that consider the difference between health risks to employees and risks to the general public. Physicians can considerably reduce the amount and costs of biohazardous waste disposal by proper identification and segregation of waste in a manner that meets their state's criteria. Using products that can be recycled may reduce the amount and costs of disposal of biohazardous waste. Processing costs also may be reduced by cooperative arrangements among medical groups or health care facilities to negotiate group disposal rates with vendors.     

Improper office disposal of needles and other sharps: an occupational hazard outside of health care institutions

An employee of a private disposal company suffered a finger needlestick injury while collecting waste at curbside from a building containing medical offices. Subsequent inspection of the contents of the garbage bags revealed the presence of used syringes and unsheathed needles. The Ministry of the Environment has developed a regulation and guidelines for the handling and disposal of biomedical waste including needles and other sharps. These specify that approved carriers and receivers are required for disposal; properly decontaminated waste is considered non-hazardous solid waste and can go to landfills. However, responsibility for curbside pickup of waste lies with municipalities; some municipalities have enacted by-laws which prohibit collection of this waste at the curbside. This incident illustrates that improper disposal of biomedical waste (including that from private practitioners' offices) may occur despite efforts to control its handling, and that needlestick injuries can occur outside of health care facilities among personnel who are not health care workers. Efforts are needed to increase the level of awareness among health professionals regarding their responsibility to ensure proper biomedical waste disposal from private offices. In addition, efforts should be made to bridge the gap between all levels of government regarding the disposal of biomedical waste.     

A comparative study on the medical waste disposal in some hospitals in Alexandria

Though healthcare services aim to reduce the health problems and prevent the potential risks to the health of the community. These services create wastes which are considered as hazardous materials due to the higher potential of infection and injury possessed by these wastes than any other type of waste. Healthcare waste management is an integral part of healthcare services, and can create harm through inadequate waste management; thus reducing the overall benefits provided by healthcare centers. In the current study, a survey for medical waste disposal was performed in order to examine the current status of medical waste disposal in some hospitals in Alexandria and to properly assess management of this type of hazardous waste. A questionnaire was designed for hospitals to assess the quantity of medical waste, collection, sorting, storage, transportation and way of final disposal. From the total waste generated by healthcare activities, almost 80% are waste similar to domestic waste. The remaining approximate of 20% is considered as hazardous waste. As Alexandria has about 3911 healthcare facilities providing medical services for people, a huge amount of medical waste are generated daily with about 208 tons generated per month. The results revealed that the most common problems associated with healthcare wastes are the absence of waste management, lack of awareness about their health hazards, insufficient financial and human resources for proper management, and poor control of waste disposal. The current situation of medical waste disposal in Alexandria is depending on incinerators. Some of these incinerators are not working anymore. Incinerations as a system is not accepted at the time being in most developed countries due to the risks associated with it and suitable substitution management system for medical waste disposal is now taking its place.     

废弃物处理——一个刻不容缓的问题

介绍了香港环保署通过１０年努力的完整的固体废弃物收运，处理及处置系统，以及他们为实现废弃物减量化和资源化所采取的策略与行动。由此提出上海浦东新区在固体废弃物管理和环卫设施建设上应加强关注；逐步按规划实施；采用多种形式设计，建造，营运环卫设施以及开展全方位宣传教育活动的建议。     

Environmental hazards of waste disposal patterns--a multimethod study in an unrecognized Bedouin village in the Negev area of Israel

The Bedouin of the Negev region of Israel are a formerly nomadic, indigenous, ethnic minority, of which 40% currently live in unrecognized villages without organized, solid waste disposal. This study, using both quantitative and qualitative methods, explored the transition from traditional rubbish production and disposal to current uses, the current composition of rubbish, methods of waste disposal, and the extent of exposure to waste-related environmental hazards in the village of Um Batim. The modern, consumer lifestyle produced both residential and construction waste that was dumped very close to households. Waste was tended to by women who predominantly used backyard burning for disposal, exposing villagers to corrosive, poisonous, and dangerously flammable items at these burn sites. Village residents expressed a high level of concern over environmental hazards, yet no organized waste disposal or environmental hazards reduction was implemented.     

Adherence to Healthcare Waste Management Guidelines among Nurses and Waste Handlers in Thika Sub-county- Kenya

Background

Despite the set guidelines on Healthcare Waste Management in Kenya, mixing of different categories of waste, crude dumping and poor incineration are still a common phenomenon in public health facilities in Thika Subcounty, Kenya. Thika Subcounty generates 560 Kilograms of healthcare waste daily, which is risk to the many patients (admission rate of 26%). This may pose a potential environmental risk and be a source of disease diffusion. This research explored the adherence to healthcare waste management waste guidelines in health care facilities among the nurses and waste handlers.

Methods

This was a cross sectional survey in which mixed methods were applied. A census and proportionate random sampling method were used. Quantitative data was analyzed using Statistical Package for Social Science (SPSS) version 20.0, while qualitative data was analyzed manually into themes.

Results

Full adherence to the seven waste disposal guidelines was low (16.3%). Knowledge on waste segregation, waste separation then disposal and means of transports were statistically significant in relation to adherence. The type of incinerator and burning status, protection maintenance and supply of adequate waste bins were also important to adherence level.

Conclusion

Adherence level was low (16.3%,) and insignificantly different among nurses and waste handlers. From this finding, compliance remains a key challenge. Strategies targeted at contextualizing waste regulations and guidelines into local settings are necessary and important. Policy makers may design and implement standard incinerators across all the health facilities. This study is not exhaustive; therefore, it is necessary to carry out a study linking poor treatment and disposal of clinical waste to purported health outcomes in Kenya.     

Management of waste disposal in medical institutions

Recently new regulations were elaborated for the management of medical wastes in Austria, FRG, Canada and USA. There is no rule laying down the requirements of the management of medical wastes in Hungary. On the basis of foreign experiences the medical wastes are proposed to range into categories as follow: I. Waste that should be handled in special way within and outside the health care facilities. II. Waste, that should be handled in a special way within the health care facilities. III. General waste (municial-type waste). Basic requirement is the segregating collection of wastes. Color-coding is proposed to identify the content of containers and bags. Incinerators combined with pyrolysis and emission control unites should be preferred to the disposal of medical wastes. The author proposes to issue a rule setting out definitions and basic principles of management of medical wastes. Individual health care establishments should prepare own written policies and measures for waste handling appropriate to their specific requirements.     

Clinical wastes in the community: local authority management of clinical wastes from domestic premises

Background: The increasing numbers of patients receiving often complex home-based health care, and the growing number of insulin-dependent diabetic, home haemodialysis and continuous ambulatory peritoneal dialysis patients, contributes to the substantial volumes of clinical waste generated from domestic premises. Arrangements for the collection and safe disposal of these potentially hazardous wastes, generally managed by local authorities, may be inadequate and, in part, unsafe.

Methods

This study audited the websites of the 526 local authorities in England, Wales, Scotland and Northern Ireland. Websites were scrutinized for information concerning clinical waste collections from domestic premises, the limits and constraints on this service, service accessibility, the practical arrangements for collection of wastes, and the health and safety issues of clinical waste management for patients who manage their own care in the community.

Results

Two hundred and sixty-two of 526 (50%) local authorities provided information on their websites concerning the collection of clinical wastes from domestic premises. Others referred patients to a district or county council, to another agency or to private contractors (n=72), while the remainder provided an in-house collection service. Weekly collections were most common, although several local authorities offered additional flexibility depending on need. Limits on the minimum or maximum volumes of waste to be collected, or on the types of clinical wastes accepted for disposal, do not support domicillary health care and create an additional burden for patients and their carers. Of particular concern was the health and safety implication of instructions to place potentially hazardous clinical wastes in a freely accessible location outside the home, at the doorstep or on the footpath, as early as 4 am on the day of collection or the night before collection.

Conclusions

The arrangements for local authority clinical waste collections from domestic premises are, in part, inadequate and may be unsafe. The arrangements do not properly support domicillary patients or their carers.     

Hospital waste management and it's probable health effect: a lesson learned from Bangladesh

A study was conducted to evaluate the current status of hospital waste management (HWM) in Bangladesh. The aim is to recognize the health effect of the existing practice, to determine the awareness level of doctors and nurses about hospital waste, to identify the weaknesses, and to provide suggestions for improvement. Hospital staff, waste pickers, and local residents were interviewed while in depth field observation, which included sample collection and laboratory analysis was also conducted. Through this investigation, it has been quite evident that a satisfactory hospital waste management system in government hospitals and several private clinics is severely lacking. At present, Bangladesh has no rigorous laws or regulation, which are enforced in this area. The waste is generally dumped together in a public place such as the hospital surroundings, the roadside or City Corporation dustbin. Many doctors and nurses are not fully aware about what constitutes as medical waste. Health care workers have only a basic understanding of health care and do not perceive handling or disposal of medial waste as a hazardous work. Laboratory analysis shows existing contamination of infectious agents in the environment. Some staff members interviewed were suffering from various kinds of infectious diseases such as viral hepatitis B/C, typhoid, skin disease/allergy, diarrhea, dysentery, tuberculosis, and malaria. During field observation it was discovered that improved HWM systems have only recently been introduced in a small number of private hospitals and clinics, some of which could be used as references to formulate guidelines for reaching the optimal at the national level. The study indicates that there is a need to improve the handling and disposal methods of hospital waste in almost all the available medical facilities. There are a few NGOs that have started awareness building and training on waste management for selected hospital staff and NGO officials. Based on the analysis of the situation, several suggestions and recommendations have been made to aid in the development of a waste management system.     

Hospital Workers' Awareness of Health and Environmental Impacts of Poor Clinical Waste Disposal in the Northwest Region of Cameroon

Abstract

Due to the infectious nature of some clinical waste, poor disposal practices have sparked concern regarding the impact on public health and the environment. Lack of sufficient knowledge of the associated risks may be a strong factor contributing to inadequate disposal practices. We conducted a survey to evaluate hospital workers' awareness of health and environmental impacts of poor clinical waste disposal in Cameroon. We randomly distributed 500 questionnaires to hospital workers in three hospitals in the Northwest Region of Cameroon in April 2008. In addition, we observed collection, segregation, transportation, and disposal of clinical waste at the three hospitals. Of 475 total respondents, most lacked sufficient awareness of any environmental or public health impacts of poor clinical waste disposal and had never heard of any policy—national or international—on safe clinical waste management. Methods of collecting, segregating, transporting and disposing clinical waste at the three hospitals was poor. The development of a comprehensive policy on efficient clinical waste management in Cameroon is imperative.     

Waste abatement: recycling, disposal practices can cut costs

On average, most healthcare facilities are doing less than they should in the areas of source reduction and recycling, and will likely do so until mandated by law. The main reasons for this are ever-tightening healthcare budgets, limited staffing, and the cost of operating recycling programs compared to the cost of general solid waste disposal. Poor record keeping also may also be hampering the final decision to recycle. This article, Part II on waste abatement practices in healthcare organizations, examines what factors facilities should consider in establishing a recycling program, and analyzes cost-effective collection and disposal practices.     

Management of medical waste in Tanzanian hospitals

A survey was conducted to study the existing medical waste management (MWM) systems in Tanzanian hospitals during a nationwide health-care waste management-training programme conducted from 2003 to 2005. The aim of the programme was to enable health workers to establish MWM systems in their health facilities aimed at improving infection prevention and control and occupational health aspects. During the training sessions, a questionnaire was prepared and circulated to collect information on the MWM practices existing in hospitals in eight regions of the Tanzania. The analysis showed that increased population and poor MWM systems as well as expanded use of disposables were the main reasons for increased medical wastes in hospitals. The main disposal methods comprised of open pit burning (50%) and burying (30%) of the waste. A large proportion (71%) of the hospitals used dust bins for transporting waste from generation points to incinerator without plastic bags. Most hospitals had low incineration capacity, with few of them having fire brick incinerators. Most of the respondents preferred on-site versus off-site waste incineration. Some hospitals were using untrained casual labourers in medical waste management and general cleanliness. The knowledge level in MWM issues was low among the health workers. It is concluded that hospital waste management in Tanzania is poor. There is need for proper training and management regarding awareness and practices of medical waste management to cover all carders of health workers in the country.     

Migration of contaminants into groundwater at a landfill site: A case study of the Avu landfill site Owerri,SE, Nigeria

The risk of groundwater pollution is regarded as the principal impact of the disposal of waste on land. In examining this problem, geophysical and geochemical studies were carried out at a solid waste disposal site in Owerri, southeastern Nigeria. The method of solid waste disposal in use is the landfill disposal method. Azimuthal electrical resistivity (ER) soundings were conducted around the site to determine the directions of contaminant transport. Surface and groundwater samples were collected and analysed to determine some geochemical parameters usually considered to be indicators of pollution from solid waste disposal. Comparative studies were made of the geochemical regime before and after the siting of the landfill. Grain size analysis of sediment samples collected at the landfill site were analysed, and found to consist of sand particles with high porosity and permeability. A collection of litho-geophysical logs of the study area gives insight about the nature of the porosity and permeability. The grain size analysis results together with the litho-geophysical logs show that contaminants/leachates can migrate through the unsaturated zone to the saturated zone into groundwater. Results indicate that the dumpsite and its management pose a threat to the health of the citizens. Surface and groundwater samples near the dumpsite are notably acidic at certain locations while the concentration of PO4 and NO3 are well above the guidelines recommended by WHO.     

Integrated disease management: arboviral infections and waterborne diarrhoea

Water-related diseases such as diarrhoeal diseases from viral, bacterial and parasitic organisms and Aedes-borne arboviral diseases are major global health problems. We believe that these two disease groups share common risk factors, namely inadequate household water management, poor sanitation and solid waste management. Where water provision is inadequate, water storage is essential. Aedes mosquitoes commonly breed in household water storage containers, which can hold water contaminated with enteric disease-causing organisms. Microbiological contamination of water between source and point-of-use is a major cause of reduced drinking-water quality. Inadequate sanitation and solid waste management increase not only risk of water contamination, but also the availability of mosquito larval habitats. In this article we discuss integrated interventions that interrupt mosquito breeding while also providing sanitary environments and clean water. Specific interventions include improving storage container design, placement and maintenance and scaling up access to piped water. Vector control can be integrated into sanitation projects that target sewers and drains to avoid accumulation of stagnant water. Better management of garbage and solid waste can reduce the availability of mosquito habitats while improving human living conditions. Our proposed integration of disease interventions is consistent with strategies promoted in several global health frameworks, such as the sustainable development goals, the global vector control response, behavioural change, and water, sanitation and hygiene initiatives. Future research should address how interventions targeting water, sanitation, hygiene and community waste disposal also benefit Aedes-borne disease control. The projected effects of climate change mean that integrated management and control strategies will become increasingly important.     

医疗废物管理系统的开发与应用研究

目的：在数字化医疗医院示范中,通过应用现代信息技术,对医疗废物的回收、存放及处置等环节进行实时跟踪和监管,使医疗废物管理更加规范。方法：基于无线网络、条形码及射频识别（RFID）等技术,开发医疗废物管理信息系统并在医院进行应用实践。结果：系统对医院内部医疗废物的收集、运送、贮存以及处置等过程进行了有效的控制及监管。结论：医疗废物管理系统规范了废物收运环节,增强了透明性,确保了安全,提升了医院管理水平。     

家庭护理医疗废物处理研究现状及展望

 近年来,随着家庭护理行业的日益兴起,家庭护理所产生的医疗废物处理问题逐渐引起关注。目前,国家及地方尚未出台相关文件对家庭护理所产生医疗废物的收集、运输、处置等环节作出要求。本文综合国内外文献就家庭护理医疗废物处理现状进行综述,以期为制定家庭护理医疗废物处理规范提供参考意见。