Search

Resumen Introduccion La pandemia por COVID-19 ha conllevado la suspension de la actividad programada en la mayoria de las Unidades de Endoscopia de nuestro medio. El objetivo del presente documento es facilitar el reinicio de la actividad endoscopica electiva de forma eficiente y segura. Material y metodos Se formulo una serie de preguntas consideradas de relevancia clinica y logistica. Para la elaboracion de las respuestas, se realizo una busqueda bibliografica estructurada en las principales bases de datos y se revisaron las recomendaciones de las principales instituciones de Salud Publica y de endoscopia digestiva. Las recomendaciones finales se consensuaron por via telematica. Resultados Se han elaborado un total de 33 recomendaciones. Los principales aspectos que se discuten son: 1) la reevaluacion y priorizacion de la indicacion; 2) la restructuracion de espacios, agendas y del personal sanitario; 3) el cribado de la infeccion, y 4) las medidas de higiene y los equipos de proteccion individual. Conclusion La AEG y la SEED recomiendan reiniciar la actividad endoscopica de forma escalonada, segura, adaptada a los recursos locales y a la situacion epidemiologica de la infeccion por SARS-CoV-2.

Granular activated carbon (GAC) exhaustion rates on pulp and paper effluent from South East Australia were found to be a factor of three higher (3.62cf. 1.47kgm(-3)) on Kraft mills compared to mills using Thermomechanical pulping supplemented by Recycled Fibre (TMP/RCF). Biological waste treatment at both mills resulted in a final effluent COD of 240mgL(-1). The dissolved organic carbon (DOC) was only 1.2 times higher in the Kraft effluent (70 vs. 58mgL(-1)), however, GAC treatment of Kraft and TMP/RCF effluent was largely different on the DOC persisted after biological treatment. The molecular mass (636 vs. 534gmol(-1)) and aromaticity (5.35 vs. 4.67Lmg(-1)m(-1)) of humic substances (HS) were slightly higher in the Kraft effluent. The HS aromaticity was decreased by a factor of 1.0Lmg(-1)m(-1) in both Kraft and TMP/RCF effluent. The molecular mass of the Kraft effluent increased by 50gmol(-1) while the molecular mass of the TMP/RCF effluent was essentially unchanged after GAC treatment; the DOC removal efficiency of the GAC on Kraft effluent was biased towards the low molecular weight humic compounds. The rapid adsorption of this fraction, coupled with the slightly higher aromaticity of the humic components resulted in early breakthrough on the Kraft effluent. Fluorescence excitation-emission matrix analysis of the each GAC treated effluent indicated that the refractory components were higher molecular weight humics on the Kraft effluent and protein-like compounds on the TMP/RCF effluent. Although the GAC exhaustion rates are too high for an effective DOC removal option for biologically treated pulp and paper mill effluents, the study indicates that advanced organic characterisation techniques can be used to diagnose GAC performance on complex effluents with comparable bulk DOC and COD loads.

Highlights ► A two–stage flotation process for HSWI fly ash treatment is proposed, which is efficient. ► Column flotation can simultaneously separate carbon constituents and PCDD/Fs from HSWI fly ash. ► The large amounts of NaCl and powder activated carbon in fly ash have effects on flotation process. ► The flotation process of fly ash is favorable to safe disposal of the final products at low cost., Hospital solid waste incinerator (HSWI) fly ash contains a large number of carbon constituents including powder activated carbon and unburned carbon, which are the major source of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) in fly ash. Therefore, the removal of carbon constituents could reduce PCDD/Fs in fly ash greatly. In this study, the effects of the main flotation parameters on the removal of carbon constituents were investigated, and the characteristics of the final product were evaluated. The results showed that loss on ignition (LOI) of fly ash increased from 11.1% to 31.6% during conditioning process. By optimizing the flotation parameters at slurry concentration 0.05 kg/l, kerosene dosage 12 kg/t, frother dosage 3 kg/t and air flow rate 0.06 m3/h, 92.7% of the carbon constituents were removed from the raw fly ash. Under these conditions, the froth product has LOI of 56.35% and calorific values of 12.5 MJ/kg, LOI in the tailings was below 5%, and the total toxic equivalent (TEQ) of PCDD/Fs decreased from 5.61 ng-TEQ/g in the raw fly ash to 1.47 ng-TEQ/g in the tailings. The results show that column flotation is a potential technology for simultaneous separation of carbon constituents and PCDD/Fs from HSWI fly ash.

UV irradiation technology as a membrane bioreactor (MBR) post-treatment was investigated and assessed. Both UV low pressure (LP) and medium pressure (MP) lamps were examined. The technology was installed in a pilot plant treating hospital wastewater to provide the study with adequate field data. The effect of the UV irradiation was enhanced with varying dosages of H2O2 to establish an advanced oxidation process (AOP). The efficiency of the pharmaceutical removal process was assessed by examining 14 micropollutants (antibiotics, analgesics, anticonvulsants, beta-blockers, cytostatics and X-ray contrast media) which are typically released by hospitals and detected with liquid chromatography coupled tandem mass spectrometry (LC–MS/MS). While the MBR treatment generally showed only a low degradation capacity for persistent pharmaceuticals, much better degradation was obtained by applying UV irradiation and H2O2 as AOP. The “conventional” cost-benefit analysis of the different technology options taking into account both electrical energy consumption and pharmaceutical removal efficiency, revealed clearly better performance of low pressure UV lamps as AOP. However, a holistic comparison between the different scenarios was carried out by evaluating their environmental impacts using the life cycle assessment (LCA) methodology. Decisive advantages were highlighted to include this approach in the decision making process.

As the potential source of environmental antibiotic pollution, large amount of biowaste generated from antibiotic fermentation manufacture highlights its beneficial utilization for resource and nutrients recovery; which is suitable for anaerobic bio-liquefaction (hydrolysis and acidification). However, its high solid content and residual antibiotics are a cause for concern. In this study, batch anaerobic experiments were conducted to evaluate the bio-liquefaction performance of lincomycin manufacturing biowaste at different total solid content (TS) and the ratios of seeding granular sludge (inoculum) to substrate (ISR). The results showed that lincomycin manufacturing biowaste had high bio-liquefaction efficiency, with the highest 10d volatile solid (VS) degradation rate being approximately 38%. The bio-liquefaction efficiency of protein could reach 100%. Predicted by response surface methodology, 1580 mg/L gVS volatile fatty acids (VFAs) and 497 mg/L gVS ammonium were obtained at a TS of 10%, ISR of 3 and solid retention time of 9.5d, which is the optimum scenario.

Hospital wastewater is considered a complex mixture populated with pathogenic microorganisms. The genetic constitution of these microorganisms can be changed through the direct and indirect effects of hospital wastewater constituents, leading to the appearance of antibiotic multi-resistant bacteria. To avoid environmental contamination hospital wastewaters must be treated. The objective of this study was to evaluate the efficiency of hospital wastewater treated by a combined process of biological degradation (septic tank) and the Fenton reaction. Thus, after septic tank biodegradation, batch Fenton reaction experiments were performed in a laboratory-scale reactor and the effectiveness of this sequential treatment was evaluated by a physico-chemical/microbiological time-course analysis of COD, BOD 5 , and thermotolerant and total coliforms. The results showed that after 120 min of Fenton treatment BOD 5 and COD values decreased by 90.6% and 91.0%, respectively. The BOD 5 /COD ratio changed from 0.46 to 0.48 after 120 min of treatment. Bacterial removal efficiency reached 100%, while biotests carried out with Scenedesmus subspicatus and Daphnia magna showed a significant decrease in the ecotoxicity of hospital wastewater after the sequential treatment. The use of this combined system would ensure that neither multi-resistant bacteria nor ecotoxic substances are released to the environment through hospital wastewater discharge.

Occurrence and behavior of fluoroquinolone antibacterial agents (FQs) were investigated in hospital wastewaters in Hanoi, Vietnam. Hospital wastewater in Hanoi is usually not treated and this untreated wastewater is directly discharged into one of the wastewater channels of the city and eventually reaches the ambient aquatic environment. The concentrations of the FQs, ciprofloxacin (CIP) and norfloxacin (NOR) in six hospital wastewaters ranged from 1.1 to 44 and from 0.9 to 17 micrgl(-1), respectively. Total FQ loads to the city sewage system varied from 0.3 to 14 g d(-1). Additionally, the mass flows of CIP and NOR were investigated in the aqueous compartment in a small wastewater treatment facility of one hospital. The results showed that the FQ removal from the wastewater stream was between 80 and 85%, probably due to sorption on sewage sludge. Simultaneously, the numbers of Escherichia coli (E. coli) were measured and their resistance against CIP and NOR was evaluated by determining the minimum inhibitory concentration. Biological treatment lead to a 100-fold reduction in the number of E. coli but still more than a thousand E. coli colonies per 100ml of wastewater effluent reached the receiving water. The highest resistance was found in E. coli strains of raw wastewater and the lowest in isolates of treated wastewater effluent. Thus, wastewater treatment is an efficient barrier to decrease the residual FQ levels and the number of resistant bacteria entering ambient waters. Due to the lack of municipal wastewater treatment plants, the onsite treatment of hospital wastewater before discharging into municipal sewers should be considered as a viable option and consequently implemented.

In order to investigate the possibility of using waste mushroom logs as a biomass resource for alternative energy production, the chemical and physical characteristics of normal wood and waste mushroom logs were examined. Size reduction of normal wood (145 kW h/tone) required significantly higher energy consumption than waste mushroom logs (70 kW h/tone). The crystallinity value of waste mushroom logs was dramatically lower (33%) than normal wood (49%) after cultivation by Lentinus edodes as spawn. Lignin, an enzymatic hydrolysis inhibitor in sugar production, decreased from 21.07% to 18.78% after inoculation of L. edodes. Total sugar yields obtained by enzyme and acid hydrolysis were higher in waste mushroom logs than in normal wood. After 24 h fermentation, 12 g/L ethanol was produced on waste mushroom logs, while normal wood produced 8 g/L ethanol. These results indicate that waste mushroom logs are economically suitable lignocellulosic material for the production of fermentable sugars related to bioethanol production.

The potential of mechanochemical treatment (MC) to degrade PCDD/Fs contained in fly ash was tested via grounding with and without calcium oxide (CaO) under atmospheric pressure. Three types of fly ash collected from medical waste incineration were compared, originating either from rotary kiln fluidized bed multi-stage incinerator using activated carbon spray (FA1, FA2), or a simple stoker incinerator without activated carbon spray (FA3). In test I: CaO to FA1 mixed at ratio of 6–60% was milled at rotational speed of 350 rpm; in test II: FA2 and FA3 without CaO were milled at rotational speed of 400 rpm. The duration of the tests was 2 h. The results from the present study indicate that (1) under two test conditions of with and without CaO, PCDD/Fs contained in real fly ash both can be degraded by mechanochemical treatment, (2) under condition of blending with CaO, the degradation efficiency of PCDD/Fs increased with increasing ratio of CaO, (3) the degradation efficiency of PCDD/Fs may increase with rotational speed increasing and (4) the destruction and dechlorination are major mechanism for PCDD/Fs degradation. These results show that mechanochemical treatment is a high potential technology for PCDD/Fs degradation in fly ash.

The aim of the present work was to study the treatment of high strength nitrate waste (40000 ppm NO(3) i.e., 9032 ppm NO(3)-N) by acclimatizing sludge initially capable of degrading dilute streams (100-200 ppm NO(3)-N). Sludge from an effluent treatment plant of a fertilizer industry was acclimatized for 15 d each at 1694, 3388, 6774 and 9032 ppm NO(3)-N in a 4 L sequencing batch reactor. Complete denitrification of extremely concentrated nitrate waste (9032 ppm NO(3)-N) using acclimatized sludge was achieved in just 6 h. During the acclimatization period, increase in nitrite peak value from zero to 5907 ppm NO(2)-N was observed, as the concentration was increased from 1694 to 9032 ppm NO(3)-N. Kinetic analysis of the nitrate and nitrite profile could reasonably support microbiological explanations for nitrite build up and changes in sludge composition.

A rapid, robust and cost-effective method of assaying the metabolic activity of the biomass of activated sludge plants would be a valuable process control tool in the wastewater treatment industry. We have developed and optimised a simple colorimetric test protocol, based on the redox dye resazurin, in which levels of reduction of the dye are proportional to cell biomass and respiration rate in both freshly sampled municipal sludges and in a surrogate activated sludge culture, Polytox. The method has been used to assess the impact of trade wastes on the activities of two municipal activated sludge populations of differing characteristics.

Objective. The intent of this project was to evaluate the efficiency of three commercial amalgam separators based on mercury and particle removal. Methods. Dental wastewater samples were collected from a 54-chair dental clinic and a one chair private dental office. Atomic absorption spectrometry was used to measure mercury, and a laser diffractometer method to determine the particle size distributions. Results. The mercury removal efficiency of the three units ranged from 26.5 to 61.8% for the 54-chair clinic and from 80.8 to 94.7% for the one chair office. Following treatment, the particle size range of the effluent was 8.3–19.2 μm for the 54-chair office and 27.5–41.4 μm for the one-chair clinic. For particle samples based on the silver–copper and copper standards, the three amalgam separators had a particle removal efficiency ranging from 92.3 to 99.9%. The initial particle size distributions for these samples were all under 100 μm. Conclusions. The efficiency of the amalgam separators is influenced by the initial concentration of the dental wastewater, the physical setup of the discharge system before the dental wastewater reaches the separators, and the addition of chemicals to the dental wastewater. In addition, it is likely that assessment of efficiency based on particle removal by weight may not be as effective as removal based on concentration.

Background Amalgam in dental wastewater is receiving increasing scrutiny from regulators because of national, state and local initiatives to reduce or virtually eliminate the discharge of mercury and mercury-containing items into the environment. Amalgam separators are considered to be one means of reducing the amount of amalgam that dental offices discharge into sewers. The purpose of this study was to evaluate the amalgam removal efficiency of commercially available amalgam separators and the total mercury concentration in the effluent from laboratory testing. Methods The authors evaluated the amalgam removal efficiency of 12 amalgam separators according to International Organization for Standardization, or ISO, Standard 11143 for Amalgam Separators. Total mercury concentration in the effluent was calculated using the mass of amalgam particles larger than 1.2 micrometers and the volume of effluent, together with U.S. Environmental Protection Agency, or EPA, Method 245.1 for amalgam particles smaller than 1.2 μm. Total dissolved mercury also was determined. Results The results show that all 12 amalgam separators exceeded the ISO 11143 requirement of 95 percent amalgam removal efficiency. Statistical differences were found in the efficiencies of the separators. Both the total mercury concentration and total dissolved mercury concentration in the effluent demonstrated large variations. Conclusions and Clinical Implications This laboratory evaluation shows that amalgam separators removed at least 96.09 percent of the amalgam in samples with particle-size distribution as specified in ISO 11143. Total mercury concentration and total dissolved mercury concentration in the effluent varied widely for each amalgam separator. Additional research is needed to develop test methods to evaluate the efficiency of amalgam separators in removing small amalgam particles, colloidal amalgam particles and ionic mercury in solution.

This is a laboratory investigation on the emissions from batch combustion of representative infectious ("red bag") medical waste components, such as medical examination latex gloves and sterile cotton pads. Plastics and cloth account for the majority of the red bag wastes by mass and, certainly, by volume. An electrically heated, horizontal muffle furnace was used for batch combustion of small quantities of shredded fuels (0.5-1.5 g) at a gas temperature of approximately 1000 degrees C. The residence time of the post-combustion gases in the furnace was approximately 1 s. At the exit of the furnace, the following emissions were measured: CO, CO2, NOx, particulates and polynuclear aromatic compounds (PACs). The first three gaseous emissions were measured with continuous gas analyzers. Soot and PAC emissions were simultaneously measured by passing the furnace effluent through a filter (to collect condensed-phase PACs) and a bed of XAD-4 adsorbent (to capture gaseous-phase PACs). Analysis involved soxhlet extraction, followed by gas chromatography-mass spectrometry (GC-MS). Results were contrasted with previously measured emissions from batch combustion of pulverized coal and tire-derived fuel (TDF) under similar conditions. Results showed that the particulate soot) and cumulative PAC emissions from batch combustion of latex gloves were more than an order of magnitude higher than those from cotton pads. The following values are indicative of the relative trends (but not necessarily absolute values) in emission yields: 26% of the mass of the latex was converted to soot, 11% of which was condensed PAC. Only 2% of the mass of cotton pads was converted to soot, and only 3% of the weight of that soot was condensed PAC. The PAC yields from latex were comparable to those from TDF. The PAC yields from cotton were higher than those from coal. A notable exception to this trend was that the three-ring gas-phase PAC yields from cotton were more significant than those from latex. Emission yields of CO and CO2 from batch combustion of cotton were, respectively, comparable and higher than those from latex, despite the fact that the carbon content of cotton was half that of latex. This is indicative of the more effective combustion of cotton. Nearly all of the mass of carbon of cotton gasified to CO and CO2 while only small fractions of the carbon in latex were converted to CO2 and CO (20% and 10%, respectively). Yields of NOx from batch combustions of latex and cotton accounted for 15% and 12%, respectively, of the mass of fuel nitrogen indicating that more fuel nitrogen was converted to NOx in the former case, possibly due to higher flame temperatures. No SO2 emissions were detected, indicating that during the fuel-rich combustion of latex, its sulfur content was converted to other compounds (such as H2S) or remained in the soot.

I ssues pertaining to the disposal of surgical waste are seldom discussed in the dermatologic surgery literature. Management of surgical waste as pertaining to the surgeon includes proper disposal of sharps in appropriate containers as well as proper handling and disposal of infectious nonsharp materials. Attention should be paid to two particular issues. First and foremost is to minimize the risk of exposure of patients, health care workers, office or operating room staff, and employees collecting or processing surgical waste to infectious materials through proper disposal of sharp and infectious waste. Although one may assume that these procedures are routinely adhered to in clinical practice, one study in New Zealand discovered that 56% of dental practices disposed of bloody swabs into the waste paper bin, and 24% disposed of contaminated sharp items into the general household refuse collection.1 Second is to minimize aberrant introduction of non-sharp waste into sharp waste disposal containers or of non-infectious waste into infectious waste bags. This is to minimize the financial and environmental costs associated with the processing of sharp and infectious waste. One study of university sharp boxes discovered that the full boxes contained only 14% appropriate sharps by weight and less than 50% appropriate sharps by volume.2 Moreover, the implementation of a waste segregation program in one hospital resulted in a 65% reduction in infectious

The management of clinical solid waste (CSW) continues to be a major challenge, particularly, in most healthcare facilities of the developing world. Poor conduct and inappropriate disposal methods exercised during handling and disposal of CSW is increasing significant health hazards and environmental pollution due to the infectious nature of the waste. This article summarises a literature review into existing CSW management practices in the healthcare centers. The information gathered in this paper has been derived from the desk study of open literature survey. Numerous researches have been conducted on the management of CSW. Although, significant steps have been taken on matters related to safe handling and disposal of the clinical waste, but improper management practice is evident from the point of initial collection to the final disposal. In most cases, the main reasons of the mismanagement of CSW are the lack of appropriate legislation, lack of specialized clinical staffs, lack of awareness and effective control. Furthermore, most of the healthcare centers of the developing world have faced financial difficulties and therefore looking for cost effective disposal methods of clinical waste. This paper emphasizes to continue the recycle-reuse program of CSW materials after sterilization by using supercritical fluid carbon dioxide (SF-CO2) sterilization technology at the point of initial collection. Emphasis is on the priority to inactivate the infectious micro-organisms in CSW. In that case, waste would not pose any threat to healthcare workers. The recycling-reuse program would be carried out successfully with the non-specialized clinical staffs. Therefore, the adoption of SF-CO2 sterilization technology in management of clinical solid waste can reduce exposure to infectious waste, decrease labor, lower costs, and yield better compliance with regulatory. Thus healthcare facilities can both save money and provide a safe environment for patients, healthcare staffs and clinical staffs.

The objective of this study is to investigate the distribution of products, i.e. gas, liquid oil and char from four different biomass samples (legume straw, corn stalk, cotton stalk and wheat straw) and analysis of the oil for the differences in the hydrocarbon composition with respect to the materials by deoxygenate liquefaction (abbr. deoxy-liquefaction). GC/MS was used to analyze the gas and oil components. According to the similarity of the natural petroleum and bio-petroleum, a new standard for bio-petroleum was established in this paper. The striking characteristic of the bio-petroleum was H/C > 1.5, oxygen content 40 MJ/kg, containing mainly alkanes, cycloalkanes and aromatic hydrocarbons. In this paper, only the oil produced from legume straw and corn stalk could be called bio-petroleum. The oil derived from different samples contained almost the same compounds, while the relative content varied based on the different content of the main biomass components (lignin and holocellulose). The gaseous products were carbon dioxide, carbon monoxide, methane and hydrogen. In addition, small amount of ethylene, ethane and propane was also observed in gas. The major gas product was carbon dioxide (81.29–86.33%) for all samples.

The paper considers UK and EC Legislation regulating clinical waste disposal. The legal definition of clinical waste is distinguished from both 'health care waste' and 'infectious waste'. Waste can be pre-treated so as to enable it to be disposed of through the normal waste stream. The legislation is looked at by reference to (i) production and storage; (ii) handling and transportation; and (iii) disposal. It is vitally important to draw up a waste management strategy. Effective segregation at source is a key factor in the waste management strategy and it will enable hospital authorities to make economic savings in waste disposal costs. The Paper considers the Duty of Care under the Environmental Protection Act 1990 and stresses the obligation on each person in the waste disposal chain to discharge the Duty. Landfilling as a method of disposal is discouraged except for waste where no possibility of infection arises. There are problems with hospital incinerators meeting modern emission standards. Requirements for licensing new incinerators are examined. The new Waste Management Licensing Regulations 1994 require applications for Waste Management Licenses to demonstrate technical and financial competence as 'fit and proper persons'. The Paper concludes by examining penalties for breach of regulatory provisions.

Pharmaceutical pollution in surface waters poses a range of risks to public health and aquatic ecosystems. Consumers contribute to pharmaceutical pollution via use and disposal of medications, though data on such behaviors is limited. This paper investigates the purchasing, use, and disposal practices among a population that has been researched only minimally to date, yet will determine pharmaceutical pollution for decades to come: young adults represented by a university student population. We employed an online, 21-question survey to examine behaviors related to pharmaceuticals among students at the University of Vermont (n = 358). Results indicate that the majority of respondents had purchased medications in the previous 12 months (94%), and had leftover drugs (61%). Contrary to previous studies of older populations, only a small proportion of students had disposed of drugs (18%); municipal trash was the primary route of drug disposal (25%), and very few students disposed drugs via flushing (1%). Less than a quarter of students were aware of drug take-back programs (24%), and only 4% had ever used take-back services. These findings indicate that the university student population may be storing a large volume of unused drugs that will require future disposal. Increasing awareness of, access to, and participation in pro-environment pharmaceutical behaviors, such as purchasing over-the-counter medication in smaller quantities and utilizing drug take-back programs, could minimize future pharmaceutical pollution from this population.

With increased worldwide awareness of environmental issues, healthcare waste (HCW) management has received much attention from both researchers and practitioners over the past decade. The task of selecting the optimum treatment technology for HCWs is a challenging decision making problem involving conflicting evaluation criteria and multiple stakeholders. In this paper, we develop an integrated decision making framework based on cloud model and MABAC method for evaluating and selecting the best HCW treatment technology from a multiple stakeholder perspective. The introduced framework deals with uncertain linguistic assessments of alternatives by using interval 2-tuple linguistic variables, determines decision makers' relative weights based on the uncertainty and divergence degrees of every decision maker, and obtains the ranking of all HCW disposal alternatives with the aid of an extended MABAC method. Finally, an empirical example from Shanghai, China, is provided to illustrate the feasibility and effectiveness of the proposed approach. Results indicate that the methodology being proposed is more suitable and effective to handle the HCW treatment technology selection problem under vague and uncertain information environment.

This paper examines medical waste management, including the common sources, governing legislation and handling and disposal methods. Many developed nations have medical waste legislation, however there is generally little guidance as to which objects can be defined as infectious. This lack of clarity has made sorting medical waste inefficient, thereby increasing the volume of waste treated for pathogens, which is commonly done by incineration. This review highlights that the unnecessary classification of waste as infectious results in higher disposal costs and an increase in undesirable environmental impacts. The review concludes that better education of healthcare workers and standardized sorting of medical waste streams are key avenues for efficient waste management at healthcare facilities, and that further research is required given the trend in increased medical waste production with increasing global GDP.

This paper presents the results of a study of an experimental system with thermal treatment (incineration) of medical waste conducted at a large complex of hospital facilities. The studies were conducted for a period of one month. The processing system was analysed in terms of the energy, environmental and economic aspects. A rotary combustion chamber was designed and built with the strictly assumed length to inner diameter ratio of 4:1. In terms of energy, the temperature distribution was tested in the rotary kiln, secondary combustion (afterburner) chamber and heat recovery system. Calorific value of medical waste was 25.0 MJ/kg and the thermal efficiency of the entire system equalled 66.8%. Next, measurements of the pollutant emissions into the atmosphere were performed. Due to the nature of the disposed waste, particular attention was paid to the one-minute average values of carbon oxide and volatile organic compounds as well as hydrochloride, hydrogen fluoride, sulphur dioxide and total dust. Maximum content of non-oxidized organic compounds in slag and bottom ash were also verified during the analyses. The best rotary speed for the combustion chamber was selected to obtain proper afterburning of the bottom slag. Total organic carbon content was 2.9%. The test results were used to determine the basic economic indicators of the test system for evaluating the profitability of its construction. Simple payback time (SPB) for capital expenditures on the implementation of the project was 4 years.

The management of health-care waste (HCW) is a major challenge for municipalities, particularly in the cities of developing countries. Selection of the best treatment technology for HCW can be viewed as a complicated multi-criteria decision making (MCDM) problem which requires consideration of a number of alternatives and conflicting evaluation criteria. Additionally, decision makers often use different linguistic term sets to express their assessments because of their different backgrounds and preferences, some of which may be imprecise, uncertain and incomplete. In response, this paper proposes a modified MULTIMOORA method based on interval 2-tuple linguistic variables (named ITL-MULTIMOORA) for evaluating and selecting HCW treatment technologies. In particular, both subjective and objective importance coefficients of criteria are taken into consideration in the developed approach in order to conduct a more effective analysis. Finally, an empirical case study in Shanghai, the most crowded metropolis of China, is presented to demonstrate the proposed method, and results show that the proposed ITL-MULTIMOORA can solve the HCW treatment technology selection problem effectively under uncertain and incomplete information environment.

Nowadays selection of the appropriate treatment method in health-care waste (HCW) management has become a challenge task for the municipal authorities especially in developing countries. Assessment of HCW disposal alternatives can be regarded as a complicated multi-criteria decision making (MCDM) problem which requires consideration of multiple alternative solutions and conflicting tangible and intangible criteria. The objective of this paper is to present a new MCDM technique based on fuzzy set theory and VIKOR method for evaluating HCW disposal methods. Linguistic variables are used by decision makers to assess the ratings and weights for the established criteria. The ordered weighted averaging (OWA) operator is utilized to aggregate individual opinions of decision makers into a group assessment. The computational procedure of the proposed framework is illustrated through a case study in Shanghai, one of the largest cities of China. The HCW treatment alternatives considered in this study include "incineration", "steam sterilization", "microwave" and "landfill". The results obtained using the proposed approach are analyzed in a comparative way.

Hospital solid waste assessment is regularly characterized by a large number of known criteria that are both qualitative and quantitative in nature. The qualitative criteria can only be assessed by human judgments, which predictably engage a variety of uncertainties such as fuzziness and ignorance. Therefore, hospital solid waste assessments need to be analyzed and modeled using approaches that can handle uncertainties. The evidential reasoning (ER) approach can be utilized for such an analysis. In this paper, perhaps for the first time, the ER approach is applied to regional hospital solid waste assessment. The assessment criteria are characterized by a set of assessment grades assumed to be commonly exclusive and communally exhaustive. All assessment information, incomplete or complete, qualitative or quantitative, and imprecise or precise, are modeled using a cohesive belief structure. The ER approach will be used to aggregate multiple hospital solid waste assessment criteria, resulting in distributed assessment for each alternative. The proposed methodology is applied for regional hospital solid waste assessment in the province of Khuzestan, Iran.

This paper discusses actions aimed at sustainable management of healthcare wastes (HCW) in China, taking into account the current national situation in this field, as well as the requirements deriving from the Stockholm Convention on Persistent Organic Pollutants and the WHO recommendations. By the end of 2005, there were 149 low-standard HCW disposal facilities in operation in China, distributed throughout different areas. According to the National Hazardous Waste and Healthcare Waste Disposal Facility Construction Plan, 331 modern, high-standard, centralized facilities will be built up in China in municipal level cities. Although incineration is still the main technical option for HCW disposal in China, it is expected that, especially for medium and small size facilities, non-incineration technologies will develop quickly and will soon become the main technical option. The basic management needs – both from the point of view of pollution control and final disposal – have been defined, and a system of technical and environmental standards has been formulated and implemented; however, there are still some shortages. This is particularly true when considering the best available techniques and best environmental practices developed under the Stockholm Convention, with which the present technological and managing situations are not completely compliant. In this framework, the lifecycle (from generation to final disposal of wastes) of HCW and holistic approaches (technology verification, facilities operation, environmental supervision, environmental monitoring, training system, financial mechanism, etc.) towards HCW management are the most important criteria for the sustainable and reliable management of HCW in China.

The management of biomedical waste is a crucial issue in health and environmental management. Rules in India were promulgated in 1998, originally with a deadline of December 2000 and extended to December 2002; however, the actual situation remains far from satisfactory. A study conducted in 2001 by CEE, New Delhi; indicated an implementation deficit. To gauge the present situation, a survey was undertaken during 2005-2006. A systematic analysis of current biomedical waste management practices in smaller nursing homes and hospitals in Delhi was carried out. A total of 53 nursing homes, with bed strengths ranging from 20 to over 200, were included. The survey results show that there is a marked improvement in the segregation practices of biomedical waste in small private hospitals and nursing homes. The majority of nursing homes and hospitals were found to be using a service provider for the collection, management, and disposal of healthcare wastes. Data was collected through a questionnaire and field visits. This paper discusses the relevant data indicative of current practices of healthcare waste management in the nursing homes and small healthcare facilities in Delhi.

Inadequate management of waste generated from injection activities can have a negative impact on the community and environment. In this paper, a report on immunization wastes management in Kano State (Nigeria) is presented. Eight local governments were selected randomly and surveyed by the author. Solid wastes generated during the Expanded Programme on Immunization were characterised using two different methods: one by weighing the waste and the other by estimating the volume. Empirical data was obtained on immunization waste generation, segregation, storage, collection, transportation, and disposal; and waste management practices were assessed. The study revealed that immunization offices were accommodated in either in local government buildings, primary health centres or community health care centres. All of the stations demonstrated a high priority for segregation of the infectious wastes. It can be deduced from the data obtained that infectious waste ranged from 67.6% to 76.7% with an average of 70.1% by weight, and 36.0% to 46.1% with an average of 40.1% by volume. Non-infectious waste generated ranged from 23.3% to 32.5% with an average of 29.9% by weight and 53.9% to 64.0% with an average of 59.9% by volume. Out of non-infectious waste (NIFW) and infectious waste (IFW), 66.3% and 62.4% by weight were combustible and 33.7% and 37.6% were non-combustible respectively. An assessment of the treatment revealed that open pit burning and burial and small scale incineration were the common methods of disposal for immunization waste, and some immunization centres employed the services of the state or local government owned solid waste disposal board for final collection and disposal of their immunization waste at government approved sites.

The quantities of waste generated by the healthcare sector in the United Kingdom (UK) have been shown to be amongst the highest in Europe. Based on a case study undertaken within the Cornwall NHS (National Health Service) in the UK, this paper reports on the results of waste minimisation trials. The schemes were able to achieve significant waste reductions in both clinical and domestic waste quantities. Indeed, a reduction in domestic bag waste in the range of 1.6-33.4%, with an average of 14.8% was realised. For clinical waste, the reduction ranged from 1.8% to 38.3%, at an average of 15.7%, with net cost benefits of nearly US$ 25,000 over the period of 1-3 years. The outcomes suggest that significant resource and financial efficiencies can be attained, but due to the many factors involved, there is a need to focus both on containment and logistics, as well as social factors for success.

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Disposal of about 1750 tons of solid wastes per day is the result of a rapid population growth in the province of Khuzestan in the south west of Iran. Most of these wastes, especially hospital solid wastes which have contributed to the pollution of the environment in the study area, are not properly managed considering environmental standards and regulations. In this paper, the framework of a master plan for managing hospital solid wastes is proposed considering different criteria which are usually used for evaluating the pollution of hospital solid waste loads. The effectiveness of the management schemes is also evaluated. In order to rank the hospitals and determine the share of each hospital in the total hospital solid waste pollution load, a multiple criteria decision making technique, namely analytical hierarchy process (AHP), is used. A set of projects are proposed for solid waste pollution control and reduction in the proposed framework. It is partially applied for hospital solid waste management in the province of Khuzestan, Iran. The results have shown that the hospitals located near the capital city of the province, Ahvaz, produce more than 43% of the total hospital solid waste pollution load of the province. The results have also shown the importance of improving management techniques rather than building new facilities. The proposed methodology is used to formulate a master plan for hospital solid waste management.

Medicine finds human blood infinitely useful. It is a source of important and sometimes controversial information about individuals, their relatives and the general public. Blood also has economic value, carries a heavy cultural freight, and can transmit dangerous diseases. Yet there is precious little sociological analysis of how these radically different applications, potentials and significations are managed in health care settings where, it is no exaggeration to claim, everyday a vast quantity of blood is produced by venepuncture. This paper focuses on blood produced in hospitals for tests. The data were derived from 19 focus groups of patients, health care professionals, and members of the public, held between 2002 and 2003, in and around the obstetrics and gynaecology department of a large London teaching hospital. Not surprisingly, all the participants had had a blood test at some time or other. Yet their responses suggest no template exists for talking about them. No-one--lay or professional--had a full picture of how blood produced for tests circulates around the hospital. Lay people tended to envisage it as remaining in a liquid form whereas health care professionals saw it as materially and substantially transformed. Participants deployed a variety of ritual and rhetorical devices that devalue blood produced for tests. Nonetheless, blood left over from tests emerged as a significant anomaly, simultaneously an excess (waste), a challenge (to use wisely), or a potential crime (illegitimate research).

Ambient measurements of seventeen 2,3,7,8-polychlorinated dibenzo-p-dioxin/dibenzofuran congeners (2,3,7,8-PCDD/Fs) have been taken in a number of monitoring programs or ad-hoc studies in Hong Kong. The longest monitoring program started at two locations in the territory in July 1997. The other monitoring efforts are ad-hoc studies, varying from a few coordinated sampling events at multiple sites to a year-long monitoring project that targeted suspected local dioxin sources. In this paper, we examined these measurements to understand the ambient levels, temporal and spatial variation, and possible sources of the 2,3,7,8-PCDD/Fs in Hong Kong. The territory-wide annual average concentration of the dioxins was 0.052 pg I-TEQ/m3 measured at the regular monitoring stations in the most recent annual cycle of 2000/2001. This level fell at the lower end of the range of dioxin concentrations measured at other urban locations around the world. The dioxin levels showed a clear seasonality in that elevated concentrations were observed in the winter and lower concentrations in the summer at all monitoring sites with one year or more regular measurements. The measurements indicated that the few known local dioxin sources, including a major chemical waste incinerator facility, landfill sites, and vehicular traffic, are not important contributors to ambient dioxins in Hong Kong. On days of high dioxin concentrations, the 2,3,7,8-PCDD/F congeners were observed to have almost identical compositions with a north-northwest to south-southeast spatial gradient in concentrations at different sampling locations in Hong Kong. This observation, along with other collaborative evidence, established a strong link between high dioxin concentration days in Hong Kong and regional transport of the polluted air masses from the north.

This paper looks at steps taken towards the development of a 10-year strategy for the management of healthcare waste from the National Health Service (NHS) in Cornwall, United Kingdom. The major issues and challenges that affect the management of waste by the NHS, including its organisational structure and collection infrastructure, are outlined. The waste flows of the main acute medical site are detailed, using waste audits of domestic and clinical bags, redundant equipment, bulky waste, and special waste. Some of the common barriers to change, such as staff habits and public perceptions, are also identified. Recommendations are made with respect to improvements in the overall organisational infrastructure and increased localised control. The recommendations also centre around the formation of strategic partnerships, within the site, between sites and at the broader level between the NHS and its surrounding community. An important challenge to be overcome is the need to progress from the concept of "waste management", to one of sustainable decision making regarding resource use, including methods of waste minimisation at the source and recycling. Staff training and awareness underpin several of the short and medium/long term solutions suggested to reduce the waste at the source and recover value from that produced. These measures could potentially reduce disposal quantities by as much as 20-30% (wt.) and costs by around 25-35%.

The amount of atmospheric pollutants emitted through the incineration of healthcare wastes can be estimated using emission factors. Emission factors have been published without including sufficient information about the types of wastes incinerated. This paper reports the first emission factors estimated for the incineration of wastes segregated into different types according to the Portuguese legislation. One controlled-air incinerator without air pollution control devices was used in the research. The main objectives of the study were: (i) to estimate the emission factors for particulate matter, dioxins, heavy metals and gaseous pollutants, according to the type of waste incinerated; (ii) to evaluate the quality of atmospheric emissions; and (iii) to define a methodology for the management of atmospheric emissions, evaluating the influence of type of waste incinerated and of the segregation method used on the emitted amounts. It was concluded that: (i) when emission factors are not associated with the type of incinerated mixture, the utility of the emission factors is highly doubtful; (ii) without appropriate equipment to control atmospheric pollution, incineration emissions exceed legal limits, neglecting the protection of human health (the legal limit for pollutant concentrations could only be met for NO(x), all other concentrations were higher than the maximum allowed: dioxins, 93-710 times; Hg, 1.3-226 times; CO, 11-24 times; SO(2), 2-5 times; and HCl, 9-200 times); (iii) rigorous segregation methodologies must be used to minimize atmospheric emissions, and incinerate only those wastes that should be incinerated according to the law. A rigorous segregation program can result in a reduction of the amount of waste that should be incinerated by 80%. A reduction in the quantity of waste incinerated results in a reduction on the amounts of pollutants emitted: particulate matter, 98%; dioxins, 99.5%; As, Cd, Cr, Mn and Ni, respectively, 90%, 92%, 84%, 77% and 92%; Hg and Pb, practically eliminated; SO(2) and NO(x), 93%; and CO and HCl, more than 99%.

Dental wastes are regulated under medical waste control regulations in most countries. Even though the quantity of hazardous wastes in dental solid wastes is a small proportion, there is still cross infection risk and potential danger for environment associated with mismanaged wastes. For this reason, knowledge of waste composition and development of proper management alternatives are necessary. In this study, the composition of solid wastes coming from eight clinics of the dental school of a University hospital in Turkey is examined. Although the waste has some variations between the two samplings, the general picture is such that the major components remain pretty much the same (in terms of %) for a fixed clinic. The composition of waste changes from one clinic to the other as expected. However, one can deduce from the data obtained that at about 35%, rubber gloves constitute close to the half of the total solid waste in almost all the clinics. Other major component is paper forming approximately 30% of the solid waste. In general, total waste coming from the clinics is related with the number of procedures conducted on patients at the clinics. Only a small fraction of the waste is hazardous indicating that at Hacettepe University School of Dentistry, hazardous waste collection rules are obeyed in most of the times.

Infection is an acknowledged hospital problem. Micro-organisms are disseminated mainly via hands but there is evidence that hand decontamination, the most important means of prevention, is performed too seldom, and not always after activities likely to result in heavy contamination. Nurses themselves are exposed to risks of infection, chiefly through contact with blood and body fluids, yet it has also been reported that gloves are not always worn during contact with patients' secretions and that the handling and disposal of sharp instruments may be performed unsafely. The study reported in this paper documents nursing behaviour in relation to hand decontamination, the use of gloves and sharps, taking into consideration a number of variables which could influence practice: availability of the expertise afforded by an infection-control nurse, clinical setting, nursing workload, knowledge and the resources available to control infection. Hands were decontaminated after 28.78% of patient contacts. Hands were decontaminated after 49.85% of activities likely to result in heavy contamination. Performance was related to nursing workload and the availability of hand decontaminating agents, especially when the nurses became busy. Use of gloves when they were available also proved good, with little evidence of wasteful use. The handling and disposal of sharps were commendable for most subjects but a few grossly unsafe incidents were nevertheless witnessed, apparently not associated with any of the variables examined.

The New York City Department of Sanitation (DSNY) is responsible for collecting and disposing of all residential waste in New York City, collecting and marketing recyclable materials from all residences, cleaning the city’s 6,200 miles of streets, and clearing the streets of ice and snow. Of DSNY’s approximately 9,500 employees, 6,400 are uniformed sanitation workers, whose primary responsibility is operating almost 4,900 “truck-shifts” (one truck, with a crew of two sanitation workers, on an 8-hour shift) per week to collect household garbage and another 2,300 truck-shifts per week to collect residential recyclables. In this paper, I describe the problems and processes associated with improper disposal of used syringes and needles in household garbage and recyclable materials in New York City.