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Approximately eight billion therapeutic injections are administered outside of medical treatment facilities annually. The management of diabetes mellitus (DM) includes self-monitoring of blood glucose levels and administration of insulin and injectable non–insulin-related medications. The lancets, needles, and syringes used for DM management are categorized as medical sharps. Improperly discarded medical sharps can cause needlestick injuries in unsuspecting individuals and thereby pose a considerable public health risk. Release of these items into the environment will likely increase with the rising worldwide prevalence of DM, and a public safety crisis will emerge if proper disposal measures are not emphasized. This article reviews the literature from various geopolitical regions and describes how a substantial number of patients with DM improperly discard their sharps. Data support the need to develop multifaceted and innovative approaches to reduce risk associated with improper disposal of DM-related medical sharps into local communities.

BACKGROUND Every day, more than 190 people in the United States die from opioid overdose. Unused opioid medications pose a risk to the patient and the community as they increase the potential for abuse or misuse. A contributing factor is lack of education on the proper disposal methods of unused opioid medications. PURPOSE The purpose of this quasi-experimental nursing study was to examine whether providing education on proper disposal of opioid medications would increase the proportion of patients who properly dispose of unused opioids. METHODS The study site's mandatory orthopaedic preoperative class was used for consenting patients. The control group did not receive targeted education on opioid disposal, whereas the intervention group did receive targeted education. A total of 86 patients were consented during Months 1 and 2 of the study. Forty-one patients were in the control group and 45 were in the intervention group. Demographic variables such as age, gender, and marital status were collected to determine whether certain demographic factors had an influence over whether or not opioids would be disposed of properly. FINDINGS Those in the intervention group who attended the class were slightly younger than those in the control group (68.2 ± 9.9 years vs. 70.3 ± 10.6 years, p = .5098), primarily male (57.5% vs. 35.0%, p = .0436), and more likely to live with a significant other (94.7% vs. 74.4%, p = .0249). Of those who had medication left over, 62.5% disposed of their unused opioid prescription in the intervention group compared with 40.7% in the control group (p = .1208). In the intervention group, 86.7% of the individuals with leftover medication disposed of it correctly compared with 63.5% in the control group (p = .3478). CONCLUSION Those who received education on appropriate opioid disposal were more likely to dispose of it in general as well as dispose of it correctly. Although not statistically significant, the findings from this study are clinically significant in that they provide direction on the importance of standardized and focused patient education on proper opioid disposal.

With the increase in the number of patients and activity of hospitals, the issue of hospital waste management (HWM) is becoming more and more challenging and worrying. In addition to financial losses, there will be irreparable damage to the ecosystem and environment which will create many problems for people (because the job of some people in the area is livestock and agriculture and they have a lot to do with their surroundings). It also doubles the need to pay attention to the issue of sustainable development (simultaneous attention to social, economic and environmental dimensions) in waste management. Moreover, the climatic and geographical conditions and lack of proper waste management in this area lead to major problems. Therefore, in this research, by developing a novel multi-objective mixed integer linear programming model, HWM is addressed in the hospitals of Sari, Iran. The aim is to design an HWM network considering sustainability, resiliency and uncertainty. In order to deal with uncertainty, a robust fuzzy programming approach is employed, and then an improved goal programming technique and Lp-metric method is proposed to solve the model. It was revealed that goal programming outperforms the Lp-metric method in terms of all objectives. Furthermore, the obtained results demonstrate the applicability and efficiency of the proposed methodology to design an efficient sustainable HWM network.

Africa is the second populous continent, and its population has the fastest growing rate. Some African countries are still plagued by poverty, poor sanitary conditions and limited resources, such as clean drinking water, food supply, electricity, and effective waste management systems. Underfunded healthcare systems, poor training and lack of awareness of policies and legislations on handling medical waste have led to increased improper handling of waste within hospitals, healthcare facilities and transportation and storage of medical waste. Some countries, including Ethiopia, Botswana, Nigeria and Algeria, do not have national guidelines in place to adhere to the correct disposal of such wastage. Incineration is often the favoured disposal method due to the rapid diminishment of up to 90% of waste, as well as production of heat for boilers or for energy production. This type of method – if not applying the right technologies – potentially creates hazardous risks of its own, such as harmful emissions and residuals. In this study, the sustainability aspects of medical waste management in Africa were reviewed to present resilient solutions for health and environment protection for the next generation in Africa. The findings of this research introduce policies, possible advices and solutions associated with sustainability and medical waste management that can support decision-makers in developing strategies for the sustainability by using the eco-friendly technologies for efficient medical waste treatment and disposal methods and also can serve as a link between the healthcare system, decision-makers, and stakeholders in developing health policies and programmes.

Background: Indiscriminate disposal of hospital wastes including mercury/amalgam wastes pose a serious threat to life and environment. There is a growing concern about biomedical waste (BMW) management among health care workers, however there are limited reports on BMW management by dental personnel in developing countries. Objectives: This study investigated the level of knowledge of BMW, observance of proper mercury hygiene and BMW management practice among public dental personnel in Lagos State, Nigeria. Methods: A cross-sectional study regarding BMW management across public hospitals in Lagos State, Nigeria was con- ducted following institutional ethics committee approval. A self-administered questionnaire was utilized to obtain data from different facilities selected by purposive and simple random sampling techniques as applicable. The questionnaires were dis- tributed among 437 respondents by convenience sampling. The resulting data were statistically tested using Chi-square and G-test with p-value < 0.05 indicating significant level. Results: Amongst 437 respondents, majority were females (62.5%) and the highest proportion fell within the age range of 25–34 years (44.4%). Only 17.2% of the respondents had good knowledge of BMW management/legislation and 4.1% had good BMW practice. Less than half (49.4%) of respondents disposed mercury-contaminated materials inside the trash and majority (92.2%) did not observe proper mercury hygiene. Significantly better mercury hygiene practices were observed in secondary facilities (p=0.040). Conclusion: A minor proportion of public dental personnel had good knowledge and practice of proper mercury hygiene and BMW management. This shows there is an urgent need for training of health personnel on proper BMW handling and disposal in developing countries like Nigeria. Keywords: Biomedical waste management; mercury hygiene; dental personnel; Nigeria.

With an estimated worldwide volume of 266 million surgeries in 2015, the call for general inhalation anesthesia is considerable. However, widely used volatile anesthetics such as N2O and the highly fluorinated gases sevoflurane, desflurane, and isoflurane are greenhouse gases, ozone-depleting agents, or both. Because these agents undergo minimal metabolism in the body during clinical use and are primarily (≥95%) eliminated unchanged via exhalation, waste anesthetic gases (WAGs) in operating rooms and postanesthesia care units can pose a challenge for overall elimination and occupational exposure. The chemical properties and global warming impacts of these gases vary, with atmospheric lifetimes of 1-5 years for sevoflurane, 3-6 years for isoflurane, 9-21 years for desflurane, and 114 years for N2O. Additionally, the use of N2O as a carrier gas for the inhalation anesthetics and as a supplement to intravenous (IV) anesthetics further contributes to these impacts. At the same time, unscavenged WAGs can result in chronic occupational exposure of health care workers to potential associated adverse health effects. Few adverse effects associated with WAGs have been documented, however, when workplace exposure limits are implemented. Specific measures that can help reduce occupational exposure and the environmental impact of inhaled anesthetics include efficient ventilation and scavenging systems, regular monitoring of airborne concentrations of waste gases to remain below recommended limits, ensuring that anesthesia equipment is well maintained, avoiding desflurane and N2O if possible, and minimizing fresh gas flow rates (eg, use of low-flow anesthesia). One alternative to volatile anesthetics may be total intravenous anesthesia (TIVA). While TIVA is not associated with the risks of occupational exposure or atmospheric pollution that are inherent to volatile anesthetic gases, clinical considerations should be weighed in the choice of agent. Appropriate procedures for the disposal of IV anesthetics must be followed to minimize any potential for negative environmental effects. Overall, although their contributions are relatively low compared with those of other human-produced substances, inhaled anesthetics are intrinsically potent greenhouse gases and pose a risk to operating-room personnel if not properly managed and scavenged. Factors to reduce waste and minimize the future impact of these substances should be considered.

Worldwide, there is a growing concern about the negative effects of infectious medical waste produced during the COVID-19 pandemic and the contamination risks associated with waste management. Therefore, measures to ensure that medical waste is managed safely and in an environmentally sound manner will avoid negative health and environmental effects from such waste, thus protecting the health of patients, health workers and the public in general. Despite that infectious medical waste generation rate is important for management planning and policy development, there is a limitation on national data availability and its accuracy, particularly in developing economies. This study analyses the infectious healthcare waste generation rates and management patterns in Lebanon before and after the COVID-19 pandemic. The estimated average of COVID-19-related infectious healthcare waste generation in this study is 39,035 kg per month or 1.3 tonnes per day, which constitute between 5% and 20% of total infectious healthcare waste in Lebanon. This study illuminates on the impact of COVID-19 on the existing challenges of waste management in Lebanon. It highlights the need for proper management and disposal of the amounts of medical waste generated to reduce contamination risks or related environmental threats, particularly during the pandemic. It also shows that Lebanon has a defective system for monitoring of waste from healthcare institutions and gaps in waste statistics. Finally, the study summarizes recommendations related to medical waste management, which can provide valuable insight for policymakers.

Background. Mismanagement of healthcare waste (HCW) during the COVID-19 pandemic can facilitate the transmission of coronavirus. Regarding this problem, there is gap of evidence in Ethiopia, and this study aimed to assess the HCW generation rate and management in Tepi General Hospital, southwest Ethiopia. Methods. Institution-based cross-sectional and case studies were conducted. The total amount of waste generated and its type among various case teams were compared using the Kruskal–Wallis test. Spearman’s rank correlation coefficient (r) was used to assess the correlation between the total numbers of patients and the total amount of HCW generated. Qualitative data were transcribed verbatim, translated to English, and analyzed with Open Code version 4.02 software, and content analysis was followed. Results. The total mean weight (±SD) of waste generation rate in all service units of the hospital was 492.5 ± 11.5 kg/day. The higher proportion (61.9%) of the total HCW produced was general waste and the remaining (38.1%) was hazardous waste. There was a statistically significant (X2 = 82.1, p < 0.001 ) difference in daily HCW generation rate among different case teams. Similarly, the hospital waste generation amount and total patient flow had a strong positive linear relationship (r = 0.7, p = 0.032 ). COVID-19-related medical wastes were not properly handled, segregated, stored, and disposed. There was a scarcity of resources needed to manage HCW, and available resources were utilized poorly. Overall, healthcare wastes were managed as usual (pre-COVID-19). Conclusion. The mean HCW generation rate in Tepi General Hospital was high. Overall, wastes were mismanaged, and COVID-19-related HCWs have been managed as usual. Availing of important resources and training the concerned bodies should be considered during the crisis of COVID-19.

Introduction Pharmacists, and thus pharmacy students, must participate in promoting awareness about proper storage and disposal of expired or unused medications. This study aimed to determine Saudi Arabian pharmacy students' knowledge and personal practices regarding storing and disposing of household medications. Methods This was a descriptive, cross-sectional, questionnaire-based study of pharmacy undergraduates or postgraduates across Saudi Arabia. The online survey was distributed to a convenience sample of participants and supplemented with snowball sampling on social media. Results: Of 807 pharmacy students who viewed the questionnaire, 464 students completed it (response rate 57.5%). Common reasons for keeping medications included having left-over medication (74%) and self-discontinuation of therapy (63.5%). The majority of students (79%) stored their medication in a bedroom or kitchen. Gender-specific variables revealed a gender difference in storing and disposing of these medications. Many students reported previously discarding medicines in the garbage (89%) or giving them to someone else to use (22%). More than half of the sample (60%) had not received any information on how to store or dispose of medications. Conclusions The current practice and knowledge of Saudi Arabian pharmacy students regarding storage and disposal of household medications was inappropriate. Concerned authorities (e.g., Ministry of Health, Ministry of Education) should provide proper education to all students on the safe storage and disposal of medications, which may necessitate curriculum reform.

Confidentiality is based on principles of deontology and ethics, which are included in French regulations and supported by the professional orders. It contributes to the respect and dignity of the patient. If this consideration of the human person is old, it has been updated to build the framework imposed by the accreditation of medical biology laboratories. Confidentiality is thus reflected in a charter of ethics, a model of which we propose here. It reflects the commitments of healthcare professionals in the processing of biological samples from patients. Confidentiality is thus applied, in a practical way, at each phase of the laboratory's activity. In the pre-analytical phase, it organizes the reception of the patient and the taking of samples, taking into account the particular case of minors. In the analytical phase, confidentiality imposes limited access to the technical premises and the organization of the flow of personnel from outside the laboratory. Finally, in the post-analytical phase, the reporting of results is regulated, depending on the type of analyses performed and the person to whom the results are to be reported (patient or prescriber). The particular case of spermiology illustrates all these points. Finally, during these phases of sample processing, document management is also a matter of confidentiality and data protection. Confidentiality is essential to the functioning of a health care structure, but it is restrictive in its day-to-day implementation. Nevertheless, it must be combined with an awareness of all staff to address the ethical issue of human dignity.

In December 2019, cases of acute respiratory illness of unknown origin were reported in Wuhan, China. The disease is caused by “severe acute respiratory syndrome coronavirus 2”. After identifying severe lung damage, injury to other organs, such as the kidney, has been identified. Peritoneal dialysis is a renal replacement therapy (RRT) and is at least as effective as other extracorporeal therapy options, with significant cost-effective advantages. However, this strategy is rarely used for the management of acute kidney injury in severe lung disease. In this review, we explore PD as an RRT strategy that may be a key instrument in countries and hospitals with limited access to all RRTs.

Background. Accumulation of unused and expired medicines at home is a source of environmental hazards and public health problems due to lack of awareness on appropriate medicine disposal methods. Therefore, the study was conducted to assess the knowledge, attitude, and practice of unused and expired medicine disposal among patients visiting Ayder Comprehensive Specialized Hospital. Methods. A descriptive cross-sectional study was conducted among 384 patients who visited Ayder Comprehensive Specialized Hospital outpatient pharmacy from April to June 2019. Convenience sampling was used to recruit the participants, and data was collected by a face-to-face interview using a structured questionnaire. The data were entered and analyzed by using SPSS version 21.0. Descriptive statistics on sample characteristics was computed, and results were presented in the form percentage using table and statements. Results. Out of the 384 respondents included in the study, 205 (53.4%) of them were males. More than half (199 (51.8%)) of the respondents did not correctly knew about medicine waste, and 233 (60.7%) of them did not have any prior information regarding medicine waste disposal instruction. But 351 (91.4%) of the participants correctly responded that inappropriate unused and expired medicine disposal can cause environmental harm. Above half (218 (56.8%)) of the respondents “agreed” about the potential risks related to having unused/expired medicines at home, and 206 (53.6%) of them “strongly agreed” that children are more vulnerable. One hundred fifty-nine respondents had unused/expired medicines in their homes. The most commonly used disposal practice for unused medicines were throwing them in a household trash as reported by 297 (77.3%) followed by flushing unused medications in toilet/sink 152 (39.6%). Throwing them away in household garbage and flushing them in toilet/sink were also the most commonly preferred disposal practice for expired medicines. Conclusion. The majority of the study participants dispose unused and expired medicine in household garbage and toilet/sink. This is against the recommendations of both national and international policies and guidelines on safe and appropriate pharmaceutical waste disposal.

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.

Background: Disposal of pharmaceutical waste among patients is a global challenge especially in developing countries like Ethiopia. Improper medication disposal can lead to health problems and environmental contaminations. Therefore, the present study aimed to assess disposal practices of unused medications among patients in public health centers of Dessie town, Northeast Ethiopia. Methods: A descriptive cross-sectional study was conducted among 263 patients in four public health centers of Dessie town, Ethiopia from March to June, 2019. Face-to-face interviews using structured questionnaires were used to collect data from each study subject. Results: The majority of the respondents, 224 (85.17%) had unused medications at their home during the study period. The most commonly reported disposal method in the present study was flushing down into a toilet 66 (25.09%). None of the respondents practiced returning unused medications to Pharmacy. Moreover, 85 (32.31%) of the respondents reported never disposing their medications and believed that it is acceptable to store medications at home for future use. Conclusion: In the present study, there was a high practice of keeping medications at home and most of the disposal practices were not recommended methods. In addition, most of the respondents did not get advice from pharmacists and other health care professionals on how to dispose off unused medications. Hence, there is a need for proper education and guidance of patients regarding disposal practices of unused medications.

Introduction On 11 March 2020, the Director-General of the World Health Organization (WHO) announced COVID-19 (Coronavirus Disease 2019) as a global pandemic Currently, no vaccines are available and there is little evidence of the efficacy of potential therapeutic agents. Furthermore, there is presumably no pre-existing immunity in the population to the new coronavirus, and it is as-sumed that everyone in the population is susceptible. Objective The aim of the procedures described in the article is to minimize the risk of human-to-human transmission of the SARS-CoV-2 (Severe acute respiratory syndrome – coronavirus 2) virus during procedures carried out in endoscopic laboratories. Brief description of the state of the art SARS-CoV-2 infection can be asymptomatic, cause severe pneumonia, or lead to death. Symptoms of COVID-19 range from none (asymptomatic) to severe pneumonia and it can be fatal. Case studies to-date indicate that this infection causes a mild illness (i.e. pneumonia or mild pneumonia) in approximately 80% of cases, and most cases recove; 14% have a more severe illness, 6% experience a critical illness. The vast majority of the most serious illnesses and deaths have occurred among the elderly and people with other chronic underlying diseases. Average progression times include: • in mild cases: from the onset of symptoms to recovery in almost 2 weeks; • in severe cases: from the onset of symptoms to recovery in 3–6 weeks, and from symptoms to death in 2–8 weeks. Conclusions Special precautions should be taken and procedures followed when performing invasive medical procedures in endoscopic laboratories in patients with specific or clinically probable SARS-CoV-2 infection. This article contains up-to-date information as at 04/04/2020.

Background Recent analysis of drinking water in South Africa found the presence of ARVs, other pharmaceutical and personal care products. The environmental and human health risk that this presents is daunting. The increased use of ARVs with poor disposal practices could be the reason for these substances being present in drinking water. Therefore, this study aimed to determine the knowledge and practices of HIV infected patients, regarding medicine disposal. Method A descriptive, cross sectional, quantitative study that utilised a structured, self-administered, questionnaire was undertaken at 3 different public ARV clinics in the eThekwini Metro of KwaZulu Natal, SA. The variables included questions on demographics, knowledge and practices of medicine disposal of ARV and other medications. Data was captured using excel spreadsheets and analysed using SPSS version 25. Chi square tests were used to compare factors between correct and incorrect knowledge and practice groups. Results Four hundred and eighty four participants agreed to participate in this study, of which the majority (71.1%) were females. Over 87% of the participants knew that improper disposal of medicines were harmful to the environment with only 28.3% knowing that there were laws governing the way medicines should be disposed. Majority of participants that had unused and expired ARVs at home disposed of these medicines. The most common route of medicine disposal for ARVs was by throwing these medicines into the bin (56.4%). Only 24.2% of participants were informed by healthcare professionals about the proper method of medicine disposal. Participants who had secondary and tertiary level of education (p = 0.043) and the ability to speak English (p = 0.001) had appropriate knowledge on medicine disposal. Conclusion This study identified that poor medicine disposal practices and lack of adequate information about the proper methods of medicine disposal were evident among the participant population. There is a need for patient education and healthcare professional intervention to ensure patients are aware of standard proper medicine disposal practices.

Introduction Inadequate biomedical waste management not only poses significant risk of infection due to pathogens such as HIV and Hepatitis B and C virus but also carries the risk of water, air, and soil pollution thereby adversely affecting the environment and community at large. Therefore, the Ministry of Health and Family Welfare commissioned implementation of an Infection Management and Environment Plan (IMEP) in health-care facilities. Hence, this study is undertaken to assess the knowledge, attitude, practice, and gaps in implementing the biomedical waste management practices at the primary health-care facilities. Methodology: A cross-sectional study was conducted among the Primary Health Centers of Hassan District. Details of knowledge, attitude, and practice of biomedical waste management were collected through observation, staff interview, and record review on the predesigned questionnaire. A score of 0, 1, and 2 was given for noncompliant (0), partially compliant (1), and fully compliant (2), respectively, based on the compliance. A scoring system was devised to evaluate the effectiveness of training as good, average, and poor. A score of >70 was considered as good, 50 to 70 as average, and Results The mean efficacy score was 63; knowledge was good with a score of 74, attitude was average with a score of 63, and practice was also average with a score of 54. Conclusion There is a need for retraining of all the staff and strict supportive supervision by the district health authorities to ease the implementation requirements.

Climate change has been described as the biggest global health threat of the 21st century1 and has significant implications for gastrointestinal (GI) health and disease,2 which is the focus of this consensus commentary provided by the World Gastroenterology Organisation (WGO) Climate Change Working Group (CCWG). The CCWG has members from 18 countries representing high-income, medium-income and low-income populations. The WGO includes gastroenterology societies from 108 countries, which represent more than 60 000 medical practitioner members. The CCWG members, who have coauthored this consensus commentary, aim to review the scientific literature on climate and GI health, to encourage education and the undertaking of actionable measures including advocacy, and to further research and collaborations within the global GI community. The CCWG’s objective is to assist GI health providers worldwide to adapt to, and mitigate, the effects of climate change on health. The CCWG has partnered with three major GI journals, which are copublishing this commentary, given the timeliness and importance of the topic.3 4 ### Climate change The earth’s climate is changing because of increasing concentrations of greenhouse gases in the atmosphere, which has already warmed by more than 1°C compared with preindustrial times. The aim of mitigation efforts is to keep the rise in global mean surface temperature (GMST) below 2°C by 2100. An increase of 2°C might not seem like a major change, but variations of similar magnitude have been associated with profound alterations of climate in the past. It is important to note that even if this somewhat arbitrary target can be met, catastrophic changes in earth ecosystems can still occur. The Intergovernmental Panel on Climate Change was established in 1988 with a mandate to assess relevant scientific literature related to climate change. It produces regular reports and updates about climate change. The Intergovernmental Panel on Climate Change projects that …

Coronavirus disease-19 has affected million of people worldwide, constituting the biggest social, economic, and health crisis since World War 2. During this pandemic, the hospitals have become hot zones for the treatment of patients. Therefore, it is important to take the appropriate protective measures and ensure the physician’s health and, especially, those who work in the intensive care units and in operating rooms. In this letter, we are trying to make a discussion regarding the measures that should be considered by the healthcare workers who are facing this invisible enemy during their effort to provide their services in the surgery rooms.

Quality challenge The Sierra Leone (SL) Ministry of Health and Sanitation’s National Infection Prevention and Control Unit (NIPCU) launched National Infection and Prevention Control (IPC) Policy and Guidelines in 2015, but a 2017 assessment found suboptimal compliance with standards on environmental cleanliness (EC), waste disposal (WD) and personal protective equipment (PPE) use. Methods ICAP at Columbia University (ICAP), NIPCU and the Centers for Disease Control and Prevention (CDC) designed and implemented a Rapid Improvement Model (RIM) quality improvement (QI) initiative with a compressed timeframe of 6 months to improve EC, WD and PPE at eight purposively selected health facilities (HFs). Targets were collaboratively developed, and a 37-item checklist was designed to monitor performance. HF teams received QI training and weekly coaching and convened monthly to review progress and exchange best practices. At the final learning session, a “harvest package” of the most effective ideas and tools was developed for use at additional HFs. Results The RIM resulted in marked improvement in WD and EC performance and modest improvement in PPE. Aggregate compliance for the 37 indicators increased from 67 to 96% over the course of 4 months, with all HFs showing improvement. Average PPE compliance improved from 85 to 89%, WD from 63 to 99% and EC from 51 to 99%. Lessons learned The RIM QIC approach is feasible and effective in SL’s austere health system and led to marked improvement in IPC performance. The best practices are being scaled up and the RIM QIC methodology is being applied to other domains.

The study was conducted with the objective of leading a situational assessment of Pune city with regard to Bio medical waste management, exploring knowledge, attitude & practices (KAP) of healthcare workers, and identifying challenges of stakeholders. Results revealed 69.2% of the hospitals had a biomedical waste management facility. Facilities like incineration, shredder, sharp pit, encapsulation, deep burial, and chemical disinfection were non- existing in 60% to 90% of hospitals. Bivariate analysis on questions with the type of employees and (KAP) was calculated. The utilization of the existing services and noncompliance are the major findings from the study.

Background: The objective of this study was to assess disposal patterns for “sharps” among a cohort of patients with diabetes mellitus (DM) receiving insulin therapy. Method: A convenience sample of inpatients and outpatients was surveyed about how they disposed of sharps, how often they reused lancets and needles, and what education they had received about proper disposal. Safe disposal was defined as discarding sharps into a formal sharps or sealable container; otherwise, disposal was categorized as unsafe. Results: Of 150 respondents, 56% were men and 75% were white. The mean (SD) age was 56 (15) years; duration of DM, 20 (13) years; and hemoglobin A1c, 8.1% (2.0%). Half the respondents reused a lancet two or more times, and 21% reused an insulin needle two or more times. Thirty-eight percent of respondents discarded lancets unsafely, and 33% discarded insulin needles unsafely, typically by throwing these items into household trash. Most respondents (75%) discarded insulin pens, vials, cartridges, insulin pump supplies, and continuous glucose monitor sensors into household trash. Most (64%) indicated that they had not received education on safe sharps-disposal practices, and 84% had never visited their municipal website for information on medical waste disposal. Conclusion: Approximately one-third of patients unsafely disposed of sharps. Unsafe disposal could cause millions of sharps to appear in the municipal solid waste stream, thereby posing a substantial public health hazard. Point-of-care patient education is important, but a broader public health campaign may be required.

Purpose To examine opioid prescription practices, patient use of opioids after laparoscopic cholecystectomy, and patient knowledge about disposal of unused medication. Design Mixed methods design with a chart review and structured phone interview. Methods Thirty-four patients were interviewed by phone and asked how many opioids were prescribed, how many excess pills they had 6 to 10 days postoperatively, and if they knew how to dispose of them. Findings Average number of excess pills ranged from 0 to 42 (mean = 14; SD = 11.7). Nearly half of patients (47%) perceived the prescribed quantity as “too many.” Seventy-one percent of patients using opioids for 5 days or less and 88% did not recall any instruction about medication disposal. Conclusions Patients often have excess prescribed opioids after laparoscopic cholecystectomy, and they do not understand proper disposal of unused medications. Education about proper disposal of unused opioids medications is a key role of perianesthesia.

Background Collecting a predefined set of blood tubes (the “rainbow draw”) is a common but controversial practice in many emergency departments (EDs), with limited data to support it. We determined the actual utilization of rainbow draw tubes at a single facility and evaluated the perceptions of ED staff regarding the utility of rainbow draws. Methods We analyzed 2 weeks of ED visits (1326 visits by 1240 unique patients) to determine blood tube utilization for initial and add-on testing, as well as the incidence of additional venipunctures. We also surveyed ED staff regarding aspects of ED phlebotomy and test ordering. Utilization data analysis was structured to satisfy specific concerns addressed in the ED staff survey. Results Observed tube utilization data showed that fluoride/oxalate, citrate, and serum separator tubes were frequently discarded unused, and that the actual utility of the rainbow draw for add-on testing and avoiding additional venipunctures was low. ED staff perceived that the rainbow draw was highly valuable, both to expedite add-on testing and to avoid additional venipunctures. Contrasting the objective (utilization data) and subjective (survey results) to drive changes in the standard ED blood collection reduced the estimated waste blood by 175 L/year. Conclusions Comparison of perceptions and objective utilization data drove process changes that were mutually agreeable to ED and laboratory staff. Although specifics of ED and laboratory work flows vary between institutions, the principles and strategy of this study are widely applicable.

The outstanding pace of technological development around the world coupled with increasing population and rapid urbanization have brought along an ever-increasing demand for healthcare services. This trend results in an increasing amount and variety of medical wastes. Accordingly, the issue of effective collection, transportation and disposal of medical wastes, specifically in large cities, has become a critical concern from the viewpoint of urban logistics and holds great importance in terms of safety. This study aims to determine the safety of hospitals in their medical waste management function. The study involves the determination of medical waste management steps, establishment of a hierarchical structure, and weighting of the criteria within the established hierarchical structure by means of the analytic hierarchy process method. Afterwards, the extent to which these criteria are adopted in hospitals was evaluated by the medical waste management officers of those hospitals, and safety scores were obtained for each hospital by associating the results with the weighted values obtained by the analytic hierarchy process method. The model proposed for medical waste management problems encountered by healthcare institutions in Istanbul was implemented for a specific region of Istanbul province, and the obtained results were analyzed. Evaluation of the opinions of the healthcare officials for determination of the medical waste management safety scores showed that the “collection” criterion has significantly higher importance than the “temporary storage” and “transportation” criteria. “The effect on hospital personnel” sub-criterion of the “collection” criterion had the highest score. This revealed the importance of the collection process that takes place between storage and transportation, for evaluating the human waste-based risks.

The incorrect disposal of medicines can be harmful to the environment. Here, we aim to understand the consumption and disposal of medicines in Brazil using online forms. 64% of the respondents have the habit to self-medicate. 66% of respondents dispose the disused or expired medicines in the garbage. 71.9% of respondents never receive any information about correct disposal of medicines. 95.2% of respondents believe that residues of medicines can be harmful to the environment. Environmental education can provide information to the population and help to mitigate pharmaceuticals pollution.

Background The inadequate management of solid waste impacts populations’ health and quality of life, and disproportionately affects developing countries. This study aims to describe a protocol for epidemiological diagnosis, the purpose being to estimate the prevalence of chronic and communicable and non communicable diseases in waste pickers, and the occupational and environmental risk factors to which these are exposed. Methods This is a cross-sectional study, based on survey design in an area of extreme social vulnerability – the largest garbage dump in Latin America. Using a multidimensional research protocol, divided in three stages: 1- The identification of the subjects, and the scheduling of tests; 2- Situational diagnosis through interviews, anthropometric evaluation, measuring blood pressure, collecting hair and nail samples to detect exposure to heavy metals and undertaking laboratory tests; 3- The return of the waste pickers to receive the test results, followed by referral to the health team and to report occupational accidents. Results One thousand twenty-five waste pickers undertook tests and interviews. The majority were women (67.0%), with 36–45 years old (45.7%), and 96.0% had children. In total, 27.3% of the participants did not attend to any school and 47.7% were educated only up to primary level. The majority of waste pickers (68.70%) reported accidents and most of them (89.69%) were related to sharp objects. The mean time working in this open dump was 15 years. According the anthropometric measure, 32.6% were overweight and 21.1% were obese. The most common reported diseases were: osteomuscular disorders (78.7%); arboviruses (28.6%); episodic diarrhea (24.9%); hypertension (24.2%); bronchitis (14.3%); intestinal worms (12.6%) and diabetes (10.1%). According to the blood tests, the values outside the reference limits were: Uric acid (23.89%); creatinine (54.06%); GGT range (16.04%); SGOT - Serum Glutamic Oxaloacetic Transaminase (5.29%); SGPT - serum Glutamic-Pyruvic Transaminase (35.52%). Conclusions This study is the first to evaluate multiple risks and diseases in the majority of waste pickers working in the largest garbage dump of a continent. These findings highlight the importance to address urgently the environmental, social and health impacts related to the management of solid waste in developmental countries to protect these workers and their families. Electronic supplementary material The online version of this article (10.1186/s12889-019-6879-x) contains supplementary material, which is available to authorized users.

Perioperative nurses use aseptic and sterile technique along with standard cleaning and disinfection practices to prevent surgical site infections. At our hospital, OR team members identified a clinical problem: the lack of a systematic approach to determine the type of postprocedure cleaning required between procedures involving patients with multi-drug resistant organisms or Clostridium difficile. Facility leaders developed a project to design and implement an evidence-based decision-making algorithm to help perioperative nurses rapidly identify the appropriate environmental cleaning procedures for these ORs. After the perioperative nurses were taught how to use the algorithm, it was put into use. Nineteen months later, the nurses completed a postimplementation survey. The results of the survey were generally positive, and the cleaning process was more standardized. We found that a decision-making algorithm was an effective tool to determine the proper postprocedure environmental cleaning between surgical procedures for patients with multi-drug resistant organisms or C difficile.

Summary Background Evidence suggests that doffing and possibly disposal of used personal protective equipment (PPE) can lead to environmental contamination. Aim To ascertain the potential for site and floor contamination when medical gloves are inappropriately disposed. Methods Fifteen healthcare workers (HCWs) disposed of gloves inoculated with bacteriophage and a chemical dye into a wastebasket, located 1.22 m away. Following each trial, designated sample areas were visually inspected with a blacklight for fluorescent dye stains and swabbed with a 3M Letheen Broth sponge to quantify the bacteriophage. Findings The area closest to the participant ( 0.61 m from the HCWs. Although the farthest distances (1.22–1.52 m) resulted in 14% bacteriophage- and 4% fluorescent dye-positive occurrences, there was no significant difference (P = 0.069) between the tracers. The bacteriophage and chemical dye indicate highest environmental contamination nearest the HCWs and both tracers could be appropriate for PPE disposal training. Conclusion HCWs use gloves every workday and potentially could contaminate surrounding surfaces and floors, during improper disposal practices. Therefore, proper disposal techniques are required to minimize pathogen transmission by establishing industry-wide policies, adequate training, and education to HCWs.

Developing countries face difficulties in implementing safe healthcare waste management (HWM) practices. It is important to holistically probe the ground situation to meet this challenge.This study aimed to examine HWM practices in public and private healthcare institutions in Pakistan.In this study we surveyed 12 public and private hospitals in a major city of Pakistan, Gujranwala. The survey consisted of waste characterization as well as targeted interviews using standardized questionnaires.The results indicated issues including lack of waste segregation, lack of sufficient knowledge and awareness regarding HWM and a high prevalence of Hepatitis C among hospital housekeeping staff. We also discovered that organizational and administrative solutions for effective HWM are as important as preventive monitoring and control.Apart from technical improvement, behavioural changes are vital for a positive change regarding HWM. Overall, this study led to an increased awareness of public health issues related to HWM that had hitherto gone unnoticed by hospital staff as well as relevant public authorities in the city.الدروس الميدانية المستفادة من استطلاع أنشطة إدارة نفايات الرعاية الصحية في باكستان.مصطفى علي.تواجه الدول النامية صعوبات في تنفيذ الممارسات الآمنة لإدارة نفايات الرعاية الصحية. ومن المهم بحث الوضع على أرض الواقع بشكل شامل من أجل مواجهة هذا التحدي.هدفت هذه الدراسة إلى فحص ممارسات إدارة نفايات الرعاية الصحية في مؤسسات الرعاية الصحية في القطاعين الحكومي والخاص في باكستان.قمنا في هذه الدراسة باستطلاع شمل 12 مستشفى حكومي وخاص في إحدى المدن الرئيسية في باكستان، وهي مدينة جوجرانوالا. ويتألف هذا الاستطلاع من تحديد خصائص النفايات ومقابلات مع الفئات المستهدفة باستخدام استبيانات موحّدة.أشارت النتائج إلى مشكلات تضمنت عدم فصل النفايات، ونقص المعرفة والوعي الكافيَيْ فيما يتعلق بإدارة نفايات الرعاية الصحية، ومعدل انتشار مرتفع لالتهاب الكبد C بين عاملي النظافة في المستشفيات. كما وجدنا أيضًا أن الحلول التنظيمية والإدارية لإدارة نفايات الرعاية الصحية الفعّالة في نفس أهمية الرصد والمكافحة الوقائية.بعيدًا عن التحسينات التقنية، تُعَدُّ التغييرات السلوكية مهمة من أجل إدخال تغيير إيجابي فيما يتعلق بإدارة نفايات الرعاية الصحية. وبشكل عام، أدّت هذه الدراسة إلى زيادة الوعي بشأن مشكلات الصحة العامة ذات الصلة بإدارة نفايات الرعاية الصحية، والتي لم يلاحظها حتى الآن العاملون في المستشفيات أو السلطات الحكومية ذات الصلة بالموضوع في المدينة.Enseignements tirés de l’étude sur le terrain de la gestion des déchets des activités de soins au Pakistan.Les pays en développement rencontrent des difficultés dans la mise en oeuvre de pratiques sûres en matière de gestion des déchets des activités de soins. Il est important d’étudier la situation sur le terrain de façon approfondie et dans sa globalité si l’on veut résoudre ce problème.La présente étude avait pour objectif d’examiner lesdites pratiques dans des établissements de soins de santé publics et privés au Pakistan.Nous avons enquêté dans 12 hôpitaux publics et privés à Gujranwala, l’une des grandes villes pakistanaises. L’enquête comprenait la caractérisation des déchets, ainsi que des entretiens ciblés reposant sur des questionnaires standardisés.Les résultats ont mis en lumière des problèmes tels que l’absence de tri des déchets, le manque de connaissance et de sensibilisation suffisantes en matière de gestion des déchets des activités de soins ainsi qu’une prévalence élevée de l’hépatite C parmi le personnel d’entretien dans les hôpitaux. Nous nous sommes aussi rendu compte que les solutions organisationnelles et administratives pour une gestion efficace dans ce domaine sont tout aussi importantes que le suivi et le contrôle préventifs.Outre les améliorations d’ordre technique, les changements de comportements sont essentiels afin d’adopter une approche positive à l’égard de la gestion des déchets des activités de soins. Dans l’ensemble, l’étude a entraîné une sensibilisation accrue aux questions de santé publique associées qui n’avaient jusqu’à présent pas été prises en considération par les personnels hospitaliers et les autorités publiques concernées de la ville.

OBJECTIVE To evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery. METHODS This prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26. RESULTS Two hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91-97) filled their opioid prescription and 64 (41%, 95% CI 34-48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67-79) discarded them; 78%, 95% CI 69-80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again. CONCLUSION Despite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.

Introduction/Objectives: A recent CDC report estimates that only 17.2% people with diabetes receive insulin. The aim of this study is to evaluate the knowledge, attitude and practice of patients with diabetes and their caregivers towards sharps waste disposal at home. Methods: A cross-sectional study conducted from February to July 2019 at the two main diabetes specialist centers in Taif, Saudi Arabia. Data collected using an interviewer-administered questionnaire, which was designed after a thorough literature review, were used to assess knowledge, attitude and practice using a total of 36 items. Result: 406 patients comprised mostly females and those who were unemployed, with a mean age of 53.2 +18.5 years and a mean DM duration of 13.6 +8.7 years. Approximately Conclusion: Patients with type 1 diabetes exhibited a significantly higher mean score in the practice only compared to patients with type 2 diabetes. A partial correlation showed a statistically significant positive correlation between practice and knowledge and a negative correlation between practice and attitude level.

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.

DISCLOSURES: No funding was received for the writing of this letter. All authors were members of the National Academies study committee to which this letter refers, with Shortliffe as the chair. All committee members who contributed to the report were themselves vetted for potential conflicts of interest, as is described in the recently published version of the report. Lieu is an employee of Kaiser Permanente and the content does not represent the official views of Kaiser Permanente. The other authors have nothing to disclose.

With the spread of the new Coronavirus, there was an increase in the generation of contaminated waste. Thus, healthcare waste management (HCWM) became even a greater challenge in hospitals due to Coronavirus easily spread. In this context, it was necessary to create tools that could aid healthcare facilities in evaluating their HCWM. Therefore, the objective of this article was to elaborate a support tool that helps in identifying the shortcomings of hospitals’ HCWM. For this purpose, the Health Service Waste Management Index was developed based on the selection of indicators in the area. The index was applied to six hospitals in the state of Minas Gerais, Brazil. Its application meet the purpose of this research, since the results in the form of an index objectively summarize the reality of the HCWM in healthcare facilities. From the six hospitals investigated, four were classified as highly efficient. However, even though most of them were well evaluated, they still have difficulties with properly training their employees, which can be even a worse problem during a pandemic, when every precaution is extremely important to reduce the spread of the disease. Therefore, beyond this article contribution related to sustainability by demanding the hospitals to check which points of HCWM should be improved, it also adds academically by developing a tool with indicators that evaluate operational, human, economic and environmental factors in an innovative way.

Graphical abstract The health sector is critical to the well-being of any country, but developing countries have several obstacles that prevent them from providing adequate health care. This became an even larger concern after the COVID-19 outbreak left millions of people dead worldwide and generated huge amounts of infected or potentially infected wastes. The management and disposal of medical wastes during and post-COVID-19 represent a major challenge in all countries, but this challenge is particularly great for developing countries that do not have robust waste disposal infrastructure. The main problems in developing countries include inefficient treatment procedures, limited capacity of healthcare facilities, and improper waste disposal procedures. The management of medical wastes in most developing countries was primitive prior to the pandemic. The improper treatment and disposal of these wastes in our current situation may further speed COVID-19 spread, creating a serious risk for workers in the medical and sanitation fields, patients, and all of society. Therefore, there is a critical need to discuss emerging challenges in handling, treating, and disposing of medical wastes in developing countries during and after the COVID-19 outbreak. There is a need to determine best disposal techniques given the conditions and limitations under which developing countries operate. Several open questions need to be investigated concerning this global issue, such as to what extent developing countries can control the expected environmental impacts of COVID-19, particularly those related to medical wastes? What are the projected management scenarios for medical wastes under the COVID-19 outbreak? And what are the major environmental risks posed by contaminated wastes related to COVID-19 treatment? Studies directed at the questions above, careful planning, the use of large capacity mobile recycling facilities, and following established guidelines for disposal of medical wastes should reduce risk of COVID-19 spread in developing countries.

Introduction The management and treatment of Medical Waste (MW) are of great concern owing to its potential hazard to human health and the environment, particularly in developing countries. In Bhutan, although guidelines exist on the prevention and management of wastes, the implementation is still hampered by technological, economic, social difficulties and inadequate training of staff responsible for handling these waste. The study aimed at assessing the awareness and practice of medical waste management among health care providers and support staff at the National Referral Hospital and its compliance with the existing National guidelines and policies. Materials and methods An observational cross-sectional study was conducted from March to April 2019. Three research instruments were developed and used; (i) Demographic questionnaire, (ii) Awareness questions, and (iii) the Observational checklist. The data was coded and double entered into Epi data version 3.1 and SPSS version 18 was used for analysis. Descriptive statistics were used to present the findings of the study. Results The majority of the respondents were female (54.1%) with a mean age of 32.2 (±7.67) years, most of whom have not received any waste management related training/education (56.8%). About 74.4% are aware of medical waste management and 98.2% are aware on the importance of using proper personal protective equipment. Only 37.6% knew about the maximum time limit for medical waste to be kept in hospital premises is 48 hours. About 61.3% of the observed units/wards/departments correctly segregated the waste in accordance to the national guidelines. However, half of the Hospital wastes are not being correctly transported based on correct segregation process with 58% of waste not segregated into infectious and general wastes. Conclusion The awareness and practice of medical waste management among healthcare workers is often limited with inadequate sensitization and lack of proper implementation of the existing National guidelines at the study site. Therefore, timely and effective monitoring is required with regular training for healthcare workers and support staff. Furthermore, strengthening the waste management system at National Referral Hospital would provide beneficial impact in enhancing safety measures of patients.

We assessed the impact of policy-based and institutional interventions to limit postoperative opioid prescribing.Retrospective cohort study of patients who underwent laparoscopic/open appendectomies, laparoscopic/open cholecystectomies, and laparoscopic/open inguinal hernia repair during a 6-month interval in 2018 (control), 2019 (post-policy intervention), and 2020 (post-institutional intervention) to assess changes in postoperative opioid prescribing patterns. A survey was collected for the 2020 cohort.Comparing the 762 patients identified in 2018, 2019, and 2020 cohorts there was a significant decrease in mean opioid tabs prescribed (23.5 ± 8.9 vs. 16.2 ± 7.0 vs. 12.8 ± 4.9, p 0.01) and mean OME dosage (148.0 ± 68.0 vs. 108.6 ± 51.8 vs. 95.4 ± 38.0, p 0.01), without a difference in refill requests. Patient survey (response rate 63%) indicated 91.4% of patients reported sufficient pain control.Formalized opioid-prescribing guidelines and statewide regulations can significantly decrease postoperative opioid prescribing with good patient satisfaction. Surgeon education may facilitate efforts to minimize narcotic over-prescription without compromising pain management.

Background The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. Methods A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value Results From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53–15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02–12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12–7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16–25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. Conclusion This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.

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., Graphical abstract Image 1

The safe disposal of unused medications is one primary prevention strategy to reduce nonmedical prescription drug use among adolescents. We sought to identify modifiable risk factors associated with disposal of unused prescription drugs by parents of adolescents residing in ten south central Kentucky counties with disposal programs. In the fall of 2017, 4148 parents of adolescents participated in an anonymous, paper-based survey. We conducted generalized logit mixed models adjusted for within-school clustering to assess the relationship between disposal behaviors and modifiable risk factors while controlling for respondents’ sociodemographic characteristics. The analytic sample consisted of parents in households in which someone had been prescribed an opioid medication within the past 12 months (N = 627). Our findings indicated that almost 42% of parents reported disposing of unused prescription medication within the past 12 months, and the majority disposed of medications at home rather than using a disposal program. Parents who perceived that any, compared to none, of their child’s close friends engaged in nonmedical prescription opioid use had higher odds of reporting use of a disposal program. Parents who were aware of disposal programs, compared to those who were not aware, had greater odds of using them, rather than not disposing at all or disposing unused prescription medications at home. Compared to parents who perceived prescription drugs to be hard for adolescents to obtain for nonmedical use, parents who believed that prescription drugs were easily accessible to adolescents for nonmedical use had lower odds of using disposal programs than disposing of medications at home. Collectively, our findings suggest that enhancing awareness of disposal programs, while addressing parents’ perceptions of their children’s peers’ use of nonmedical prescription opioids, should be considered to facilitate the disposal of unused medications and optimize current public health prevention efforts related to adolescent nonmedical use of these drugs.

Face masks and respirators are the most widely used intervention measures for respiratory protection. In the wake of COVID-19, in response to shortages and lack of availability of surgical masks and respirators, the use of cloth masks has become a research focus. Various fabrics have been promoted with little evidence-based foundation and without guidelines on design principles for optimal performance. In these circumstances, it is essential to understand the properties, key performance factors, filter mechanisms and evidence on cloth masks materials. The general community might also need to decontaminate and reuse disposable, single-use devices as a last resort. We present an overview of the filter materials, filter mechanisms and effectiveness, key performance factors, and hydrophobicity of the common disposable masks, as well as cloth masks. We also reviewed decontamination methods for disposable respiratory devices. As an alternative to surgical masks and respirators, we recommend a cloth mask made of at least three layers (300–350 threads per inch) and adding a nylon stocking layer over the mask for a better fit. Water-resistant fabrics (polyesters/nylon), blends of fabrics and water-absorbing fabrics (cotton) should be in the outside layer, middle layer/layers and inside layer, respectively. The information outlined here will help people to navigate their choices if facing shortages of appropriate respiratory protection during the COVID-19 pandemic.