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The sudden outbreak and prolonged impact of the global novel coronavirus disease (COVID-19) epidemic has caused an increase in demand for medical products, such as masks and protective clothing, leading to an exponential increase in the generation of medical waste. As medical waste under the epidemic is highly infectious, it poses a great danger to human health. Therefore, with the proliferation of medical waste, it has become crucial to construct a reverse logistics recycling network that can handle medical waste quickly and efficiently. In this study, we construct a multi-period medical waste emergency reverse logistics network siting model with the objectives of minimum cost, minimum safety risk, and minimum time for the safe and quick disposal of medical waste. The model considers disposal capacity bottlenecks of existing facilities. Based on an empirical analysis using the COVID-19 epidemic in New York City, USA, as a case study, we find that the use of a suitable number of synergistic facilities and the establishment of temporary medical waste disposal centers are viable options for handling the dramatic increase in medical waste during the peak of the COVID-19 epidemic., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Abstract: Healthcare workers (HWs) perform a critical role not only in the clinical management of patients but also in providing adequate infection control and prevention measures and waste management procedures to be implemented in healthcare facilities. The aim of this study was to evaluate the awareness and knowledge of COVID-19 infection control precautions and waste management procedures among HWs in Saudi Arabian hospitals.This was a descriptive, cross-sectional study. Information on knowledge, awareness, and practice of infection control and waste management procedures were obtained from the HWs using a structured questionnaire. A thematic analysis was used to analyze the data.Our findings indicated that most of the study participants were knowledgeable, with a mean score of 78.3%. In total, 92.5%, 90.3%, and 91.7% of the participants were aware of the infection control precautions, COVID-19 waste management procedures, the availability of infection control supplies, respectively. HWs' Knowledge regarding waste management and infection control procedures correlated significantly with sex (P ≤ .001 and <.001), education (P = .024 and .043), and working experience (P = .029 and .009), respectively.Most participants appreciated the importance of their role in infection control, surveillance, and monitoring of the ongoing safety practices in their patients as well as their facilities and communities., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.)

During the COVID-19 pandemic, disposable masks, protective clothing, gloves, and nasopharyngeal swabs collected by nucleic acid testing formed a large amount of medical waste. Medical waste has strict temporary storage time requirements in hospitals, which need to be transported to medical waste disposal plants within the specified time. However, as most of disposal plants are far away from downtown, they also need to be responsible for the transportation and disposal of medical waste in many hospitals, and put forward higher requirement for transportation routes. Rapid and safe disposal of all types of medical waste generated by COVID-19 is crucial to the prevention and control of the epidemic. This paper designs the transportation route optimization model using Anylogic simulation software based on the regional distribution of 118 tertiary hospitals and 2 large medical waste disposal plants in Beijing, China. At the same time, transportation routes of 118 tertiary hospitals in the morning peak, evening peak, all-day, and ordinary periods were simulated based on the Beijing traffic index in 2017. On this basis, through the analysis of the simulation data, the selection of medical waste transport routes for 118 tertiary hospitals in the morning peak, evening peak, all day, and ordinary periods is further clarified, so as to ensure that medical waste can be transported to the medical waste disposal plant in the shortest time. The shortest path and fastest speed transport mode, medical waste transport data set, and the selection of transport mode of 118 tertiary hospitals formed by this research provide certain reference experience for the rapid and safe transport of medical waste during the epidemic period, and also provides corresponding data support for medical waste transportation management in the post-epidemic era and medical waste transportation decision-making when facing major public health problems., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Health-care waste (HCW) may pose a risk to human health and the environment because of its infectious and/or toxic properties. This study was conducted to evaluate the quantity and composition of all the HCW generated by different producers in Antalya, Turkey, using data obtained from two online systems. Accordingly, this study explored the trends in healthcare waste generation (HCWG) between 2010 and 2020 and the impact of COVID-19 on HCWG by comparing the post- and pre-COVID-19 patterns based on the data obtained from 2,029 different producers. The collected data were based on the waste codes reported by the European Commission, were characterised based on the definition of the World Health Organization, and were further analysed according to the healthcare types defined by the Turkish Ministry of Health to characterize HCW. The findings indicate that the main HCW contributor was infectious waste (94.62 %), most of which was generated by hospitals (80 %). This is due to the inclusion of only HCW fractions in this study and to the definition of infectious waste considered. This study indicates that the categorisation into the type of HCSs may be a good option to assess the increase of HCW quantities, in accordance with the service type, size, and the effects of COVID-19. The correlation results for hospitals offering primary HCS revealed a strong relationship between the HCWG rate and the population per year. This approach may help estimate future trends to promote better HCW management practices for the specific cases considered, and it can even be applied to other cities., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Hospitals release significant quantities of wastewater (HWW) and biomedical waste (BMW), which hosts a wide range of contaminants that can adversely affect the environment if left untreated. The COVID-19 outbreak has further increased hospital waste generation over the past two years. In this context, a thorough literature study was carried out to reveal the negative implications of untreated hospital waste and delineate the proper ways to handle them. Conventional treatment methods can remove only 50%-70% of the emerging contaminants (ECs) present in the HWW. Still, many countries have not implemented suitable treatment methods to treat the HWW in-situ. This review presents an overview of worldwide HWW generation, regulations, and guidelines on HWW management and highlights the various treatment techniques for efficiently removing ECs from HWW. When combined with advanced oxidation processes, biological or physical treatment processes could remove around 90% of ECs. Analgesics were found to be more easily removed than antibiotics, β-blockers, and X-ray contrast media. The different environmental implications of BMW have also been highlighted. Mishandling of BMW can spread infections, deadly diseases, and hazardous waste into the environment. Hence, the different steps associated with collection to final disposal of BMW have been delineated to minimize the associated health risks. The paper circumscribes the multiple aspects of efficient hospital waste management and may be instrumental during the COVID-19 pandemic when the waste generation from all hospitals worldwide has increased significantly., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

COVID-19 pandemic-borne wastes imposed a severe threat to human lives as well as the total environment. Improper handling of these wastes increases the possibility of future transmission. Therefore, immediate actions are required from both local and international authorities to mitigate the amount of waste generation and ensure proper disposal of these wastes, especially for low-income and developing countries where solid waste management is challenging. In this study, an attempt is made to estimate healthcare waste generated during the COVID-19 pandemic in Bangladesh. This study includes infected, ICU, deceased, isolated and quarantined patients as the primary sources of medical waste. Results showed that COVID-19 medical waste from these patients was 658.08 tons in March 2020 and increased to 16,164.74 tons in April 2021. A top portion of these wastes was generated from infected and quarantined patients. Based on survey data, approximate daily usage of face masks and hand gloves is also determined. Probable waste generation from COVID-19 confirmatory tests and vaccination has been simulated. Finally, several guidelines are provided to ensure the country's proper disposal and management of COVID-related wastes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

The surge of medical waste (MW) generated during the COVID-19 pandemic has exceeded the disposal capacity of existing facilities. The timely, safe, and efficient emergency disposal of MW is critical to prevent the epidemic spread. Therefore, this review presents the current status of MW generation and disposal in China and analyzes the characteristics and applicability of emergency disposal technologies. The results show that movable disposal facilities can dispose of infectious MW on site, even though most of their disposal capacity is at a low level (<5 t/day). Co-disposal facilities need to be reformed completely for emergency MW disposal, in which separate feeding systems should be taken seriously. Specifically, municipal solid waste (MSW) incineration facilities have great potential to improve emergency MW disposal capacities. For hazardous waste incineration facilities, compatibility of the wastes must be matched to the composition and calorific value of the waste. As for cement kiln, MW can only be used as an alternative fuel instead of a raw material for cement. Based on the environmental risk and technical adaptability, the six emergency MW disposal technologies are recommended to be prioritized as follows: movable microwave sterilization, movable steam sterilization, movable incineration, co-incineration with hazardous waste, co-incineration with MSW and co-disposal in cement kilns. Infectious MW, especially COVID-19 MW, should be prioritized for disposal by centralized and movable disposal facilities, while non-infectious MW can be disposed of using co-disposal facilities. All stakeholders should strengthen the delicacy management of the end-of-life stage of MW, including collection, classification, packaging identification, transportation, and disposal. Currently, it is necessary for centralized disposal enterprises to follow the emergency disposal operation flowchart. From a long-term strategic perspective, making full use of regional movable and co-disposal facilities in the megacities can effectively enhance the emergency MW disposal capacity., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Medical waste (MW) has exploded since the COVID-19 pandemic and aroused great concern to MW disposal. Meanwhile, the energy recovery for MW disposal is necessary due to high heat value of MW. Harmless disposal of MW with economically and environmentally sustainable technologies along with higher energy recovery is urgently required, and their energy recovery efficiencies and environmental impacts reduction due to energy recovery are key issues. In this study, five MW disposal technologies, i.e. rotary kiln incineration, pyrolysis incineration, plasma melting, steam sterilization and microwave sterilization, were evaluated and compared via energy recovery analysis (ERA), life cycle assessment (LCA), and life cycle costing (LCC) methods. Furthermore, three MW incineration technologies with further energy recovery and two sterilization followed by co-incineration technologies were analyzed to explore their improvement potential of energy recovery and environment benefits via scenario analysis. ERA results reveal that the energy recovery efficiencies of "steam and microwave sterilization + incineration" are the highest (≥83.4%), while that of the plasma melting is the lowest (19.2%). LCA results show that "microwave sterilization + landfill" outperforms others while the plasma melting exhibits the worst, electricity is the most significant contributor to the environmental impacts of five technologies. Scenario analysis shows that the overall environmental impact of all technologies reduced by at least 45% after further heat utilization. LCC results demonstrate that pyrolysis incineration delivers the lowest economic cost, while plasma melting is the highest. Co-incineration of sterilized MW and municipal solid waste could be recommended., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2021 Elsevier B.V. All rights reserved.)

At present, strategies for controlling the COVID-19 pandemic have made significant and strategic strides; however, and the large quantities of healthcare treatment waste have become another important "battlefield". For example, in Wuhan, the production rate of healthcare waste in hospitals, communities, temporary storage, and other units was much faster than the disposal rate during the COVID-19 pandemic. Improving the efficiency of healthcare waste transfer and treatment has become an important task for government health and environmental protection departments at all levels. Based on the situation of healthcare waste disposal in Wuhan during the critical period of the pandemic, this paper analyzes and studies green governance principles and summarizes the problems that exist in the current healthcare waste management system. Through the establishment of temporary storage facilities along transit routes, digital simulation and bionic experiments were carried out in the Hongshan District of Wuhan to improve the efficiency of healthcare waste transfer. Furthermore, this study discusses the coordination and cooperation of government, hospitals, communities, and other departments in the healthcare waste disposal process and provides guiding suggestions for healthcare waste disposal nationwide in order to deal with potential risks and provide effective references in all regions.

The COVID-19 pandemic has imposed a global emergency and also has raised issues with waste management practices. This study emphasized the challenges of increased waste disposal during the COVID-19 crisis and its response practices. Data obtained from the scientific research papers, publications from the governments and multilateral organizations, and media reports were used to quantify the effect of the pandemic towards waste generation. A huge increase in the amount of used personal protective equipments (facemasks, gloves, and other protective stuffs) and wide distribution of infectious wastes from hospitals, health care facilities, and quarantined households was found. The amount of food and plastic waste also increased during the pandemic. These factors caused waste treatment facilities to be overwhelmed, forcing emergency treatment and disposals (e.g., co-disposal in a municipal solid waste incinerator, cement kilns, industrial furnaces, and deep burial) to ramp up processing capacity. This paper discussed the ways the operation of those facilities must be improved to cope with the challenge of handling medical waste, as well as working around the restrictions imposed due to COVID-19. The study also highlights the need for short, mid, and longer-term responses towards waste management during the pandemic. Furthermore, the practices discussed in this paper may provide an option for alternative approaches and development of sustainable strategies for mitigating similar pandemics in the future., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

This paper proposes a personalized comprehensive cloud-based method for heterogeneous multi-attribute group decision-making (MAGDM), in which the evaluations of alternatives on attributes are represented by LTs (linguistic terms), PLTSs (probabilistic linguistic term sets) and LHFSs (linguistic hesitant fuzzy sets). As an effective tool to describe LTs, cloud model is used to quantify the qualitative evaluations. Firstly, the regulation parameters of entropy and hyper entropy are defined, and they are further incorporated into the transformation process from LTs to clouds for reflecting the different personalities of decision-makers (DMs). To tackle the evaluation information in the form of PLTSs and LHFSs, PLTS and LHFS are transformed into comprehensive cloud of PLTS (C-PLTS) and comprehensive cloud of LHFS (C-LHFS), respectively. Moreover, DMs' weights are calculated based on the regulation parameters of entropy and hyper entropy. Next, we put forward cloud almost stochastic dominance (CASD) relationship and CASD degree to compare clouds. In addition, by considering three perspectives, a comprehensive tri-objective programing model is constructed to determine the attribute weights. Thereby, a personalized comprehensive cloud-based method is put forward for heterogeneous MAGDM. The validity of the proposed method is demonstrated with a site selection example of emergency medical waste disposal in COVID-19. Finally, sensitivity and comparison analyses are provided to show the effectiveness, stability, flexibility and superiorities of the proposed method. [ABSTRACT FROM AUTHOR]

Waste has become a pivotal public health and environmental problem during the COVID-19 pandemic. In this interdisciplinary review, we move beyond the 'coronalitter' and 'coronawaste' discourses, which have come to dominate public imaginaries of waste, to consider less-visible dimensions of waste infrastructures and systems. We demonstrate how waste is coming to matter in new ways that offer opportunities for reconfiguring health research. By examining the literature addressing the impacts of COVID-19 on the geographies of waste, we shed light on how waste is being problematised and researched through logics of public, environmental, and occupational health. We argue that these logics structure understandings and practice, whilst drawing attention to the overlaps and limits that allow links across disciplinary silos and problem domains to be forged. Developing a multi-logics approach, the paper outlines a research agenda for approaching waste as a critical public health problem at a time of intersecting health crises. [ABSTRACT FROM AUTHOR]

COVID-19's developing trend has put the waste management systems of governments all over the world in jeopardy. The increasing rise of infectious medical waste has now become a serious problem. This paper presents a multi-period multi-objective model for designing a medical waste management system during the COVID-19 pandemic. The model aims to reduce total costs of infectious medical waste management while also reducing the environmental impact of treatment centers, disposal centers, and transportation. It also aims to maximize the suitability of treatment technology based on social considerations and reduce the risk associated with processing and transporting COVID-19 waste. Different strategic and operational decisions are taken into account that include the selection of treatment technologies, the location of treatment and disposal centers, the flow of generated medical waste between facilities, and the number of vehicles required for the medical waste transport. The model tackles the uncertainty associated with model parameters, and it uses a credibility-based possibilistic programming method to deal with uncertainties. The suggested model is solved using an interactive fuzzy programming method and the importance of social indicators for selecting treatment technology is determined using the fuzzy best–worst approach. The effectiveness of the model is demonstrated by a practical case study in Shiraz, Iran. The numerical results can help system designers to achieve the most suitable trade-off between the sustainability goals and the safety viewpoint. [ABSTRACT FROM AUTHOR]

BACKGROUND: Biomedical waste can potentially compromise the environment and public safety if not safely disposed. OBJECTIVE: The aim was to assess the understanding and safe practices of biomedical and dental waste amongst the dental practitioners and practical year students amid the COVID-19 pandemic. METHODS: A structured and validated questionnaire consisting of 21 closed ended questions was used to collect data from dental practitioners and students working in hospitals and clinics. The questionnaire was distributed in paper and digital form amongst the participants. Descriptive analysis was performed for categorical and numerical variables. Spearman correlation test was used to assess the relationship between awareness and waste disposal practices of dentists. A p-value of≤0.05 was considered as statistically significant. RESULTS: More than three fourth of the participants were aware of proper dental waste disposal steps. One half was aware of the color-coded segregation of biomedical waste management. Two third of the participants were deploying safe biomedical waste practices. Nearly 68% subjects allocated separate labeled containers for disposal of COVID-19 suspected patient's waste. Furthermore, 71.63% participants were practicing PCR test before aerosol procedures. While 88.65% participants believed that the COVID-19 pandemic has increased the financial burden in terms of safe practices and dental waste management. CONCLUSION: The awareness and practices of the participants towards dental waste management was found to be moderate. Satisfactory COVID-19 prevention and transmission measures were observed amongst the participants. BMW management lessons should be included in the academic curriculum and training program needs to be adopted for mass awareness. [ABSTRACT FROM AUTHOR]

In recent years, Nigeria has experienced increased outbreaks of Monkeypox, Ebola, Lassa fever, and the latest Coronavirus disease (COVID-19) pandemic. As a result of the epidemics, highly infectious materials such as con- taminated needles, syringes, soiled bandages, and contagious disposable personal protective equipment are on the rise. This has resulted in vast volumes of medical waste generation in Nigeria. This study employs relevant scientific works of litera- ture in scholarly sites of Web of Science and Scopus, governments, and multilateral organizations regulatory guidelines for COVID-19. This is to conduct a critical ana- lysis of COVID-19ʹs impact on medical waste management and disposal measures in Nigeria during the pandemic. Results show that, with over 143.01% increase in less than a year, Nigeria’s daily average COVID-related medical waste increased from 131.24 tons/day in August 2020 to 318.92 tons/day in January 2021, leading to environmental pollution and a high risk of infection among health workers. The paper further highlights the total daily estimates of PPE (facemasks) used during the COVID-19 pandemic as 171,908,091. Medical Waste Management (MWM) chal- lenges persist in most developing and least developed nations as the global popu- lation and healthcare services rise. As it stands, Nigeria’s population is expected to exceed that of the United States by 2050, and with frequent outbreaks of an epidemic, there is a need for an effective MWM plan. Rapid revalidation and appraisal of the Sustainable Development Goals and the Water, Sanitation, and Hygiene (WASH) for health care facilities in most developing countries is required. The inclusion of epidemic and pandemic readiness, natural disasters preparedness, and climate change is critical in the global objectives of the Sustainable Development Goals. [ABSTRACT FROM AUTHOR]

Medical waste management in Taiwan is a crucial issue due to its highly environmental and human health risks. The main objectives of this paper were to analyse the status of medical waste generation and treatment in recent years, and also address the discussions on the impacts of coronavirus disease 2019 (COVID-19) on its generation in the first half of 2020. It showed that the reported quantities have slightly increased from 35,747 metric tonnes (Mt) in 2016 to 40,407 Mt in 2019, showing an average increase by 4.17%. This rate of increase was consistent with the hospital services. When classified by the reported codes, the C-type waste (infectious waste) accounted for about 89% of the reported quantities, which indicated an annual increase by 4.14% during the same period. In addition, the medical waste treatment in 2019 was mainly dependent on the commissioned treatment (80.18%), followed by the recycling (18.53%) and the self-treatment (1.29%). Furthermore, the impact of COVID-19 on the medical waste generation in Taiwan was not significant in the first half of 2020 compared to the data during the years of 2016–2019. It was indicated that the consistent trend was observed at the daily confirmed COVID-19 cases in Taiwan during this period. Obviously, the reduction in the hospital medical services during the COVID-19 outbreak should be offset by the increase in medical waste generation from the medical services. In order to try to ensure safe and complete destruction of the COVID-19 virus, all the waste generated from the healthcare facilities should be treated in the incineration plants. [ABSTRACT FROM AUTHOR]

BACKGROUND: The COVID-19 global pandemic brought several challenges to occupational safety and health practice. One of these is the need to (re)assess the occupational risks, particularly, biological risks. OBJECTIVE: The purpose of this work is to promote guidance to occupational safety and health practitioners when conducting a biological risk assessment in this context. METHODS: The main steps of the biological risk assessment are explained with some inputs regarding the novelty posed by SARS-CoV-2 and an example of a qualitative risk assessment method is presented. Also, its application to two different activities was exemplified. RESULTS: In both cases, the assessment considered that vulnerable workers were working from home or in medical leave. The results showed low or medium risk level for the assessed tasks. For medium risk level, additional controls are advised, such maintain social distancing, sanitize instruments/equipment before use, use proper and well-maintained PPE (when applicable), and promote awareness sessions to spread good practices at work. Employers must be aware of their obligations regarding biological risk assessment and OSH practitioners must be prepared to screen and link the abundance of scientific evidence generated following the outbreak, with the technical practice. CONCLUSIONS: This paper could be an important contribution to OSH practice since it highlights the need to (re)assess occupational risks, especially biological risk, to ensure a safe return to work, providing technical guidance. [ABSTRACT FROM AUTHOR]

Introduction. The article presents information on the activities of inpatient facilities for infectious diseases during the pandemic of the new coronavirus disease 2019, taking into account current regulatory documents. The authors reviewed the principles of hospital zoning and patient controlled movement in hospitals for infectious diseases. The paper deals with the organization of the admission departments and equipment of the diagnostic units of hospitals for infectious diseases, providing a graphical presentation of an individual isolation unit (Melzer box) including description of the control and management system for safe access to infectious units. The characteristics of engineering and communication systems, disposal of hazardous medical waste, catering, navigation systems, operational remote communication between doctors and patients, application of barcoding for patient identification and medical records are also discussed. The purpose of this paper was to: Identify the shortcomings of the existing regulatory framework concerning the management and organization of health care institutions that provide medical care to patients with the new coronavirus infection; Identify areas that require adjustments, given the modern requirements for high quality treatment, as well as to ensure epidemiological safety for medical staff and patients; Specify additional requirements for hospitals for infectious diseases, which should be taken into account when planning major repairs, reconstruction and construction of new medical facilities for providing health care during the pandemic of new coronavirus disease 2019 and other highly infectious infections. [ABSTRACT FROM AUTHOR]

In the last several decades, Iran's ecosystem has suffered due to the careless usage of natural resources. Cities have grown in an uneven and non-normative way, and poor project management has been a major issue, particularly in large cities. An even greater number of environmental factors and engineering regulations are not relevant to projects. Because of this, in order to ascertain a project's environmental impact, an environmental impact assessment (EIA), is required. Using the rapid impact assessment matrix (RIAM) is one method of applying it to EIA. Reducing subjectivity brings objectivity and transparency. During the COVID-19 pandemic, a thorough EIA was carried out for the Tehran project utilizing the RIAM and other possibilities. This research is the first to combine the methodology that was discussed during the incident. Through the use of the RIAM technique, the environmental impact of COVID-19 was to be quantified in this inquiry. The research examined lockdown procedures and the COVID-19 pandemic to create an EIA indicator. In a real-world case study conducted in Tehran, Iran, the impact of the initiative was evaluated using the RIAM methodology during the COVID-19 epidemic. The results demonstrated that COVID-19 had both beneficial and harmful effects. Decision-makers were effectively informed about the COVID-19 pandemic's environmental consequences on people and the environment, as well as how to minimize negative effects, according to the EIA technique that used RIAM. This is the first research to integrate the EIA during a crisis, such as the COVID-19 pandemic, with the RIAM approach. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has resulted in an unprecedented amount of medical waste, presenting significant challenges for the safe disposal of hazardous waste. A systematic review of existing research on COVID-19 and medical waste can help address these challenges by providing insights and recommendations for effective management of the massive medical waste generated during the pandemic. This study utilized bibliometric and text mining methods to survey the scientific outcomes related to COVID-19 and medical waste, drawing on data from the Scopus database. The results show that the spatial distribution of medical waste research is unbalanced. Surprisingly, developing countries rather than developed countries lead research in this area. Especially, China, a major contributor to the field, has the highest number of publications and citations, and is also a centre of international cooperation. The main study authors and research institutions are also mainly from China. And the research on medical waste is a multidisciplinary field. Text mining analysis shows that COVID-19 and medical waste research is mainly organized around four themes: (i) medical waste from personal protective equipment; (ii) research on medical waste in Wuhan, China; (iii) threats of medical waste to the environment and (iv) disposal and management of medical waste. This would serve to better understand the current state of medical waste research and to provide some implications for future research. [ABSTRACT FROM AUTHOR]

A safe and effective medical waste transport network is beneficial to control the COVID-19 pandemic and at least decelerate the spread of novel coronavirus. Seldom studies concentrated on a two-phase COVID-19 medical waste transport in the presence of multi-type vehicle selection, sustainability, and infection probability, which is the focus of this paper. This paper aims to identify the priority of sustainable objectives and observe the impacts of multi-phase and infection probability on the results. Thus, such a problem is formulated as a mixed-integer programming model to minimise total potential infection risks, minimise total environmental risks, and maximise total economic benefits. Then, a hybrid solution strategy is designed, incorporating a lexicographic optimisation approach and a linear weighted sum method. A real-world case study from Chongqing is used to illustrate this methodology. Results indicate that the solution strategy guides a good COVID-19 medical waste transport scheme within 1 min. The priority of sustainable objectives is society, economy, and environment in the first and second phases because the total Gap of case No.35 is 3.20%. A decentralised decision mode is preferred to design a COVID-19 medical waste transport network at the province level. Whatever the infection probability is, infection risk is the most critical concern in the COVID-19 medical waste clean-up activities. Environmental and economic sustainability performance also should be considered when infection probability is more than a certain threshold. • Two-phase COVID-19 medical waste transport with infection probability is studied. • A mixed-integer programming model to optimise sustainability is formulated. • A hybrid solution strategy is designed to solve the proposed multi-objective model. • The priority of sustainable objectives is society, economy, and environment. [ABSTRACT FROM AUTHOR]

Environmental pollution has been a major concern for researchers and policymakers. A number of studies have been conducted to enquire the causes of environmental pollution which suggested numerous policies and techniques as remedial measures. One such major source of environmental pollution, as reported by previous studies, has been the garbage resulting from disposed hospital wastes. The recent outbreak of the COVID-19 pandemic has resulted into mass generation of medical waste which seems to have further deteriorated the issue of environmental pollution. This necessitates active attention from both the researchers and policymakers for effective management of medical waste to prevent the harm to environment and human health. The issue of medical waste management is more important for countries lacking sophisticated medical infrastructure. Accordingly, the purpose of this study is to propose a novel application for identification and classification of 10 hospitals in Iraq which generated more medical waste during the COVID-19 pandemic than others in order to address the issue more effectively. We used the Multi-Criteria Decision Making (MCDM) method to this end. We integrated MCDM with other techniques including the Analytic Hierarchy Process (AHP), linear Diophantine fuzzy set decision by opinion score method (LDFN-FDOSM), and Artificial Neural Network (ANN) analysis to generate more robust results. We classified medical waste into five categories, i.e., general waste, sharp waste, pharmaceutical waste, infectious waste, and pathological waste. We consulted 313 experts to help in identifying the best and the worst medical waste management technique within the perspectives of circular economy using the neural network approach. The findings revealed that incineration technique, microwave technique, pyrolysis technique, autoclave chemical technique, vaporized hydrogen peroxide, dry heat, ozone, and ultraviolet light were the most effective methods to dispose of medical waste during the pandemic. Additionally, ozone was identified as the most suitable technique among all to serve the purpose of circular economy of medical waste. We conclude by discussing the practical implications to guide governments and policy makers to benefit from the circular economy of medical waste to turn pollutant hospitals into sustainable ones. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic not only poses an unprecedented threat to global health but also severely disrupts the natural environment and ecosystems. Mitigating the adverse impacts of plastic-based personal protective equipment (PPE) waste requires the cooperation of professionals from various fields. This paper discusses a novel, cleaner approach to soil stabilisation by repurposing the nitrile gloves into a sustainable road material to improve the mechanical properties of expansive clay soil as pavement subgrade. For the first time, extensive geotechnical testings, including standard compaction, unconfined compressive strength (UCS), unsoaked California bearing ratio (CBR), repeated load triaxial (RLT), and swelling-shrinkage tests, were carried out to investigate the engineering performance of different proportions of the shredded nitrile gloves (SNG) (e.g., 1%, 1.5%, 2%) were blended with expansive clay (EC). In addition, surface roughness, scanning electron microscopy (SEM), and X-ray micro-CT analyses were conducted, and images were obtained to study the microstructural modification of the EC-SNG mixtures. The experimental results indicated that the blend of expansive clay with SNG helped in increasing the compressive strength, resilient modulus, and CBR and assisted in reducing the swelling and shrinkage of the soil. SEM and surface roughness analyses indicated the interaction between the soil matrix interface and the rough surface of the SNG. The main reasons for increasing the strength and stability of clay soil could be attributed to the high tensile strength of the SNG and the formation of the three-dimensional grid, and friction between the soil particles and SNG. According to the X-ray micro-CT test results, the incorporation of SNG led to an increase in closed porosity. [Display omitted] • An innovative approach to mitigate the problem of medical waste generation associated with COVID-19 is presented. • A cleaner and sustainable subgrade was developed by using discarded nitrile gloves. • The addition of 1.5% SNG to the soil provided the highest strength properties. • SNG reduced the swelling and shrinkage of the expansive clay subgrade. [ABSTRACT FROM AUTHOR]

Context: The Coronavirus Disease 2019 (COVID-19) pandemic that began in 2019 has affected more than 232 million people around the world with over 4.7 million deaths as on September 30, 2021. Amidst the crisis, there has been increased generation of biomedical-waste (BMW). In April 2021, a 62% rise was observed compared to 123 metric tonnes of waste generated in February 2021. The hospital waste mismanagement has diverse ramifications as it affects the patients, healthcare workers (HCWs), public, environment, and economy. Proper BMW management aims to reduce generation, ensures efficient collection, handling and safe disposal so that it controls infection and improves safety. Aims: The present study was conducted to assess the knowledge among medical professionals regarding BMW segregation, transport, and treatment. Settings, Design, Methods, and Materials: A google formed based survey was done to assess the knowledge regarding management of COVID-19 BMWamong HCWs (MBBS students, residents, and consultants) associated with tertiary care hospitals of North India. Results: The knowledge score was: for segregation - 27.4%, 59.6%, and 49.8%; transport from site of generation to site of disposal - 63.6%, 89.1%, and 95.2%; disposal - 29%, 71.9%, and 68.2%; overall score - 41.4%, 67.9%, and 61.3% among the students, residents, and consultants respectively. We found that participants with greater years of experience (residents and consultants) had better knowledge as compared to that of the students (P =0.032). Conclusion: We found a mean score of 56.9% which is more than that of few low- and middle-income countries but less than that of European countries. The chances of infection directly correlate with lower knowledge score. Appropriate evidence-based, judicious use of PPE as per the settings and guidelines should be followed. Training aspects, periodic evaluation, and assessment should be strengthened, both for practising medical professionals and for students, to ensure a safe and sustainable healthcare system. [ABSTRACT FROM AUTHOR]

Though global health care delivery systems have been under inevitable pressure and risks from the ongoing coronavirus disease (COVID-19) pandemic, our natural human environment is also increasingly threatened. The reason is that efforts to contain the pandemic have resulted in a vast generation of medical waste from disused personal protective equipment, such as facemasks, face-shields, hand-gloves, hand-sanitisers, and related single-use products. Unprofessional management of medical waste can result in environmental contagion. This article, adopting an analytical approach, argues that COVID-19 waste represents a mode of contagion, and hence demands special regulatory attention, management, and disposal procedures at all levels of governance. The article offers an epidemiological perspective on COVID-19 waste and its place in medical waste. It provides insights into the best practices for managing COVID-19 waste and examines how global objectives and frameworks visibly support COVID-19 medical waste management globally. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic forces people to be vaccinated as early as possible. The COVID-19 vaccination program certainly raised the medical waste volume all over the world, including in Bangladesh. Numerous recent reports showed a fragile medical waste management system in Bangladesh; during the pandemic, the situation became worse. In addition, the nation-wide ongoing COVID-19 vaccination processes have been posing an extra burden to the existing biomedical waste management in the country. Failing to proper management of this waste might be a threat to human and environmental health. Therefore, the study investigated the current COVID-19 vaccine waste management practices in Bangladesh and made a comparison to the proposed standard operating procedures of international organizations and vaccine waste management practices of two other countries (USA and India). The study was carried out through a mixed methodological approach such as qualitative and quantitative, including a questionnaire survey in 15 Upazila of 4 Districts (Dhaka, Narayanganj, Manikganj, and Gazipur) of Bangladesh. The article focused on a nation-wide legitimate COVID-19 vaccination waste estimation, strength, weakness, opportunity, and threat (SWOT) analysis and drivers, pressure, state, impact, and response (DPSIR) framework analysis to identify the present state of medical waste management in the study area. The study found an excellent segregation system (100%) but very poor waste handling (35.5%) along with very poor syringes and sharps disposal method (open burning without buried 46.6%) and poor vials disposal method (without disinfection/open dump 52%) of vaccine waste. It is estimated that about 58 and 257.85 tonnes of syringes (with needles and packaging) and vaccine vials (Sinopharm 2 doses) waste have been generated since the mass-vaccination program started. Upon SWOT analysis, good separation techniques, poor waste management (ex-situ), enough space for management, and environmental and human health concerns were mostly identified as a strength, weakness, opportunity, and threat, respectively. Finally, a DPSIR framework was prepared for vaccine waste generation and its consequences in the studied area. This study will be useful to prepare a suitable vaccination waste management system in Bangladesh. [ABSTRACT FROM AUTHOR]

In this study, the hospital waste generation rates and compositions in Delhi were examined temporally and spatially during the first COVID-19 wave of April 2020. A total of 11 representative hospitals located in five districts were considered. The pre-COVID hospital waste generation rates were relatively consistent among the districts, ranging from 15 to 23 tonne/month. It is found that the number of hospital beds per capita may not be a significant factor in the hospital waste quantity. Strong seasonal variations were not observed. All districts experienced a drastic decrease in generation rates during the 1-month lockdown. The average rates during the COVID period ranged from 12 to 24 tonne/month. Bio-contaminated and disposable medical product wastes were the most common waste in Delhi's hospitals, representing 70–80% by weight. The changes in waste composition were however not spatially consistent. The lockdown appeared to have had a higher impact on hospital waste generation rate than on waste composition. The findings are important as the design and operation of a waste management system are sensitive to both waste quantity and quality. Waste records at source helped to minimize waste data uncertainties and allowed a closer examination of generation trends. [ABSTRACT FROM AUTHOR]

To prevent the spread of the COVID-19 pandemic, 2019 has seen unprecedented demand for medical equipment and supplies. However, the problem of waste treatment has not yet been given due attention, i.e., the traditional waste treatment process is done independently, and it is not easy to share the necessary information. Especially during the COVID-19 pandemic, the interaction between parties is minimized to limit infections. To evaluate the current system at medical centers, we also refer to the traditional waste treatment processes of four hospitals in Can Tho and Ho Chi Minh cities (Vietnam). Almost all hospitals are handled independently, lacking any interaction between the stakeholders. In this article, we propose a decentralized blockchain-based system for automating waste treatment processes for medical equipment and supplies after usage among the relevant parties, named Medical-Waste Chain. It consists of four components: medical equipment and supplies, waste centers, recycling plants, and sorting factories. Medical-Waste Chain integrates blockchain-based Hyperledger Fabric technology with decentralized storage of medical equipment and supply information, and securely shares related data with stakeholders. We present the system design, along with the interactions among the stakeholders, to ensure the minimization of medical waste generation. We evaluate the performance of the proposed solution using system-wide timing and latency analysis based on the Hyperledger Caliper engine. Our system is developed based on the hybrid-blockchain system, so it is fully scalable for both on-chain and off-chain-based extensions. Moreover, the participants do not need to pay any fees to use and upgrade the system. To encourage future use of Medical-Waste Chain, we also share a proof-of-concept on our Github repository. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVES: During the Coronavirus disease 2019 pandemic, an effective and efficient medical waste management plan is required to prevent disease transmission from the Coronavirus disease 2019 viral solid wastes. Screening stations are critical locations where solid Coronavirus disease 2019 wastes are created. Solid trash collection and management strategies for screening stations must be studied as they are the first point of origin for solid Coronavirus disease 2019 wastes. The goal of this study is to evaluate the level of healthcare workers' knowledge in the medical waste management field in Jordanian Coronavirus disease 2019 screening stations, with an emphasis on understanding and implementing Jordanian medical waste management protocols, by examining the awareness, perspective, and practice about the many aspects of Coronavirus disease 2019 wastes. METHODS: A study sample (n = 78) involving technicians, nurses, and physicians working at various screening stations in Jordan's public and private sectors was evaluated. From April 2021 to September 2021, a cross-sectional survey involving questionnaires was carried out. The survey included questions on medical waste management knowledge and awareness among healthcare personnel regarding the Coronavirus 2019 medical waste administrative and collection procedures. There are various limitations to this cross-sectional study that should be noted. This is a study conducted among health care employees when an overwhelming amount of coronavirus disease cases were being recorded locally and worldwide, affecting transportation ability and minimizing time spent with screening station personnel. FINDINGS: The outcomes of the first module of the questionnaire revealed a high degree of medical waste management knowledge and awareness among healthcare staff. On the other hand, nurses demonstrated the highest awareness and application of COVID-19 medical waste administrative procedures. Furthermore, the results of the third module revealed that the private sector fails to successfully execute national and international procedures, with the most significant negative responses among other categories. CONCLUSION: It was concluded that Jordan's solid waste collection and disposal methods were effectively implemented, which might aid in the virus eradication. Even though most Jordanian screening stations have effectively implemented knowledge and awareness regarding solid Coronavirus disease 2019 wastes management practices, there is a need to undertake periodic training and continuous monitoring with a specific focus on the appropriate administrative and collecting processes for both technicians, and private sector stations. [ABSTRACT FROM AUTHOR]

Management of healthcare waste has gained wide attention in the recent years. This work reviews recent sustainable management of healthcare waste practices, the importance of legalizations, role of clinical waste producing bodies, emerging management trends, and treatment technologies. Furthermore, waste generated in the treatment processes and the health and environmental impacts of recent technologies are also examined. Sustainable assessment of technologies, to this point, revealed that in often cases, autoclave assisted with shredder could be a better alternative for the treatment of hazardous healthcare wastes while landfilling of healthcare waste received the lowest ranking. Studies are required to consider more reliable assessment methods for treatment technologies. This work can serve educators, researchers, as well as all the medical staff from nurses to doctors and volunteers who tirelessly contribute to the society in keeping people away from many diseases including the current global pandemic outbreak due to severe acute respiratory syndrome coronavirus 2 through the best and most sustainable practices in medical waste management. [ABSTRACT FROM AUTHOR]

The World Health Organization (WHO) recognized a novel coronavirus as the causative agent of a new form of pneumonia. It was subsequently named COVID-19 and reported as the source of a respiratory disease occurrence starting in December 2019 in Wuhan, Hubei Province, China. It has been affirmed a public health emergency of international significance by the World Health Organization. It is regarded as a subset of the severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome (MERS); COVID-19 is triggered by a betacoronavirus called SARS-CoV-2, which affects the lower respiratory tract and occurs in humans as pneumonia. A variety of drugs, such as remdesivir and favipiravir, are currently undergoing clinical trials to evaluate for the management of COVID-19. The effect of the pandemic as well as the epidemic that follows through the life cycles of various recycled plastic is evaluated, particularly those required for personal safety and health care. In response to the growth in COVID-19 cases worldwide, the energy and environmental impacts of these lifecycle management have risen rapidly. However, significant hazardous waste management concerns arise due to the need to assure the elimination of residual pathogens in household and medical wastes. This review article summarizes the preventive and environmental management of COVID-19. [ABSTRACT FROM AUTHOR]

In Italy, as well as in almost all countries, the use of masks in public with several other measures has been an important health measure during the ongoing COVID-19 pandemic. The correct use of masks is essential, as a wrong use and disposal may increase the rate of contagious. Herein, we report a descriptive study evaluating the knowledge and use, reuse and disposal of masks in community settings. An anonymous questionnaire called MaSK (Mask uSe and Knowledge) questionnaire was developed and offered to patients referring at our dermatologic outpatient clinic. A total of 2562 full complete patients' questionnaires were considered for the study. Our results showed that awareness and information campaigns aimed at the general population are urgently needed in order to implement a correct use of masks and limit as much as possible the infection rate. [ABSTRACT FROM AUTHOR]

• We reviewed the performance of medical waste management during the pandemic. • Medical institutions have a storage space shortage on 17% of the days on average. • Temporary disposal methods are effective supplements during emergencies. • COVID-19 led to a five-fold increase in Wuhan's treatment capacity. The global pandemic caused by the 2019 coronavirus (COVID-19) has led to a dramatic increase in medical waste worldwide. This tremendous increase in medical waste is an important transmission medium for the virus and thus poses new and serious challenges to urban medical waste management. This study investigates the response of medical waste management to the COVID-19 pandemic and subsequent changes in Wuhan City based on the most detailed data available, including waste generation, storage, transportation, and disposal. The results show that despite a 5-fold increase in the demand for daily medical waste disposal in the peak period, the quick responses in the storage, transportation, and disposal sectors during the pandemic ensured that all medical waste was disposed of within 24 hours of generation. Furthermore, this paper discusses medical waste management during future emergencies in Wuhan. The ability of the medical waste management system in Wuhan to successfully cope with the rapid increase in medical waste caused by major public health emergencies has important implications for other cities suffering from the pandemic and demonstrates the need to establish resilient medical emergency systems in urban areas. [ABSTRACT FROM AUTHOR]

A pneumonia-like disease of unknown origin caused a catastrophe in Wuhan city, China. This disease spread to 215 countries affecting a wide range of people. World health organization (WHO) called it a pandemic and it was officially named as Severe Acute Respiratory Syndrome Corona virus 2 (SARS CoV-2), also known as Corona virus disease (COVID-19). This pandemic compelled countries to enforce a socio-economic lockdown to prevent its widespread. This paper focuses on how the particulate matter pollution was reduced during the lockdown period (23 March to April 15, 2020) as compared to before lockdown. Both ground-based and satellite observations were used to identify the improvement in air quality of Pakistan with primary focus on four major cities of Lahore, Islamabad, Karachi and Peshawar. Both datasets have shown a substantial reduction in PM 2.5 pollution levels (ranging from 13% to 33% in case of satellite observations, while 23%–58% in ground-based observations) across Pakistan. Result shows a higher rate of COVID-19 spread in major cities of Pakistan with poor air quality conditions. Yet more research is needed in order to establish linkage between COVID-19 spread and air pollution. However, it can be partially attributed to both higher rate of population density and frequent exposure of population to enhanced levels of PM 2.5 concentrations before lockdown period. • The COVID-19 has caused severe health concerns and economic disruptions worldwide. • Larger spread of COVID-19 can be associated with elevated levels of PM 2.5 • The lockdown had a positive change in severely polluted cities of Pakistan. • Besides improvement, it has posed sever challenges of environmental monitoring. • Restricted mobility resulted in pile up and improper disposal of hospital waste. [ABSTRACT FROM AUTHOR]

In recent years, municipal authorities especially in the developing nations are battling to select the best health care waste (HCW) disposal technique for the effective treatment of the medical wastes during and post COVID-19 era. As evaluation of various disposal alternatives of HCW and selection of the best technique requires considering various tangible and intangible criteria, this can be framed as multi-criteria decision-making (MCDM) problem. In this paper, we propose an assessment framework for the selection of the best HCW disposal technique based on socio-technical and triple bottom line perspectives. We have identified 10 criteria on which the best HCW disposal techniques to be selected based on extant literature review. Next, we use Fuzzy VIKOR method to evaluate 9 HCW disposal alternatives. The effectiveness of the proposed framework has been demonstrated with a real-life case study in Indian context. To check the robustness of the proposed methodology, we have compared the results obtained with Fuzzy TOPSIS (Technique of Order Preference Similarity to the Ideal Solution). The results help the municipal authorities to establish a methodical approach to choose the best HCW disposal techniques. Our findings indicate that incineration is the best waste disposal technique among the available alternatives. Even if the dataset indicates 'incineration' is the best method, we must not forget about the environmental concerns arising from this method. In COVID time, incineration may be the best method as indicated by the data analysis, but "COVID" should not be an excuse for causing "Environmental Pollution". • Health care waste disposal technique selection is a serious concern during COVID-19. • We propose Fuzzy VIKOR based method for selecting the best disposal technique. • This work has been grounded on Triple Bottom Line and Socio-Technical perspectives. • The proposed framework has been validated with a real-life case study. • The effectiveness of the proposed method has been compared with Fuzzy TOPSIS. [ABSTRACT FROM AUTHOR]

Generation of healthcare waste from different patient care activities in hospitals, pathology labs and research centres has been a matter of great concern for environmental and social bodies across the world. This concern comes from its infectious and hazardous nature which brings life taking disease such as human immunodeficiency virus and Hepatitis-B. Moreover, with the outbreak of corona virus disease 2019 (COVID-19) pandemic across the world, healthcare waste has become even more infectious like never before and showing its potential for claiming lives if not disposed properly. Additionally, the COVID-19 has put up another challenge in terms of exponentially increasing demand for personal protective equipments for healthcare workers such as doctors, nurses, ward boys, and sanitation workers. In this paper, seven criteria related to smart healthcare waste disposal system infused by circular economy aspects to recover value from disposables are identified and analysed using a decision making trial and evaluation laboratory (DEMATEL) method. The criteria have been prioritized by its importance and net cause and effect relationship through a causal diagram. Two criteria, (i) digitally connected healthcare centres, waste disposal firms and pollution control board, and (ii) providing a pollution control board's feedback app to public and other stakeholders, feature as strong reasons for a smart healthcare waste disposal system. Conclusively, this study provides a causal relationship model among the intertwined drivers of industry 4.0 and circular economy for developing a smart healthcare waste disposal system enriched with the benefits of circular economy. [ABSTRACT FROM AUTHOR]

• A novel healthcare waste location-routing problem is developed with a new perspective in healthcare logistics networks. • A stochastic essence for the emission of contamination is considered. • The management of medical wastes in Coronavirus Disease 2019 is focused. • A real case study is modeled to manage the logistics of infectious and non-infectious healthcare wastes. • A Multi-Objective Water-Flow like Algorithm with novel operators is developed and compared with the others. This paper presents a novel healthcare waste location-routing problem by concentrating on a new perspective in healthcare logistics networks. In this problem, there are healthcare, treatment, and disposal centers. Locations of healthcare centers are known, however, it is required to select appropriate locations for treatment, recycling, and disposal centers. Healthcare wastes are divided into infectious and non-infectious wastes. Since a great volume of healthcare wastes are infectious, the emission of contamination can have obnoxious impacts on the environment. The proposed problem considers a stochastic essence for the emission of contamination which depends on the transferring times. In this respect, transferring times between healthcare and treatment centers have been considered as normal random variables. As transferring time increases, it is more likely for the contamination to spread. Having visited a treatment center, infectious wastes are sterilized and they will no longer be harmful to the environment. This research develops a bi-objective mixed-integer mathematical formulation to tackle this problem. The objectives of this model are minimization of total costs and emission of contamination, simultaneously. Complexity of the proposed problem led the researchers to another contribution. This study also develops a Multi-Objective Water-Flow like Algorithm (MOWFA), which is a meta -heuristic, to solve the problem. This algorithm uses a procedure based on the Analytical Hierarchy Process (AHP) to rank the non-dominated solutions in the archive set. By means of a developed mating operator, the MOWFA utilizes the best ranked solutions of the archive in order to obtain high quality offspring. Two neighborhood operators have been designed for the MOWFA as the local search methods. Extensive computational experiments have been conducted to evaluate the effectiveness of the MOWFA on several test problems compared with other meta -heuristics, namely the Multi-Objective Imperialist Competitive Algorithm (MOICA) and Multi-Objective Simulated Annealing (MOSA). These experiments also include a real healthcare waste logistic network in Iran. The computational experiments demonstrate that our proposed algorithm prevails these algorithms in terms of some well-known performance evaluation measures. [ABSTRACT FROM AUTHOR]

Background: Optimal personal protective equipment (PPE) preparedness is key to minimize healthcare workers (HCW) infection with COVID- 19. This two-phase survey evaluated PPE preparedness (adherence to Ministry of Health India (MoH) PPE-recommendations; HCW-training; PPE-inventory; PPE-breach management) in Indian intensive care units (ICU). Materials and methods: The phase 1 survey was distributed electronically to intensivists from 481 Indian hospitals between March 25, 2020, and April 06, 2020, as part of a multinational survey. Phase 2 was repeated in 320 Indian hospitals between April 20, 2020, and April 30, 2020. Results: Response rate was 25% from 22 states. PPE practice varied between states and between private, government, and medical colleges. Between phase 1 and phase 2, all aspects of PPE training improved: donning/doffing 43% vs 66%, respectively; p value <0.01); safe waste disposal practices (38% vs 52%; p value = 0.09); intubation training (18% vs 31%; p value = 0.05); and transport (18% vs 31%; p value = 0.05). Perception of confidence for adequate PPE-training improved from 39 to 53% (p value = 0.26). In all, 47 to 60% ICUs adhered to MoH recommendations. Wearing N95-masks at all times increased from 47 to 60% (p value = 0.89). Very few ICUs provided quantitative/qualitative N95 masks fit testing (12% vs 29%; p value <0.01). Low-cost practices like "buddy-system" for donning-doffing (27% vs 44%; p value = 0.02) and showering after PPE breach (10% vs 8%; p value = 0.63) were underutilized. There was reluctance to PPE reuse. In all, 71% were unaware/diffident about PPE inventory. Conclusion: Despite interstate variability, most ICUs conformed to MoH recommendations. This survey conducted during initial pandemic phase demonstrated improved PPE preparedness uniformly across India with scope for further improvement. We suggest implementation of quality improvement measures to improve pandemic preparedness and minimize HCW infection rates, focused on regular PPE training, buddy system, and PPE-breach management. [ABSTRACT FROM AUTHOR]