Abstract
There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals’ healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal–Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.
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References
Advisory Committee on Immunization Practices (ACIP), Immunization of health-care workers: recommendations of the Advisory Committee on Immunization Practices (ACIP) and the Hospital Infection Control Practices Advisory Committee (HICPAC) (1997) MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, 46(RR-18).
Alagöz AZ, Kocasoy G (2008) Determination of the best appropriate management methods for the health-care wastes in İstanbul. Waste Manage 28(7):1227–1235. https://doi.org/10.1016/j.wasman.2007.05.018
Ali M, Wang W, Chaudhry N, Geng Y (2017) Hospital waste management in developing countries: a mini review. Waste Manage Res 35(6):581–592
Alter MJ (1995) Epidemiology of hepatitis C in the west. Seminars in Liver Diseasedoi. https://doi.org/10.1055/s-2007-1007259
Altin S, Altin A, Band E, Cerit O (2003) Determination of hospital waste composition and disposal methods: a case study. Pol J Environ Stud 12(2):251–255
Alwabr GMA, Al-Mikhlafi AS, Al-Hakimi SA, Dughish MA (2016) Determination of medical waste composition in hospitals of Sana, a city, Yemen. J Appl Sci Environ Manag 20(2):343–347. https://doi.org/10.4314/jasem.v20i2.15
André SCS, Veiga TB, Takayanagui AMM (2016) Geração de Resíduos de Serviços de Saúde em hospitais do município de Ribeirão Preto (SP). Brasil Engenharia Sanitária e Ambiental 21:123–130. https://doi.org/10.1590/S1413-41520201600100140092
Ansari M, Ehrampoush MH, Ahmadi FM, E, (2019) Dynamic assessment of economic and environmental performance index and generation, composition, environmental and human health risks of hospital solid waste in developing countries; a state of the art of review. Environment International, Elsevier 132(August):p105073. https://doi.org/10.1016/j.envint.2019.105073
Bakiu R, Durmishaj S (2018) Medical waste effects and management: overview and future directions SF. J Environ Earth Science 1(2):1019
Campion N, Thiel CL, Wood, NC, Swanzy L, Landis AE, Bilec MM (2015) Sustainable healthcare and environmental life-cycle impacts of disposable supplies: a focus on disposable custom packs, Journal of Cleaner Production, 94https://doi.org/10.1016/j.jclepro.2015.01.076
Cesaro A, Belgiorno V (2017) Sustainability of medical waste management in different sized health care facilities, waste and biomass valorization 8(5). https://doi.org/10.1007/s12649-016-9730-y.
Chaerul M, Mand T, Shekdar AV (2008) A system dynamics approach for hospital waste management. Waste Manage 28(2):442–449. https://doi.org/10.1016/j.wasman.2007.01.007
Delmonico DVdG, Santos HHdo, Pinheiro MAP, de Castro R, de Souza RM (2018) Waste management barriers in developing country hospitals: case study and AHP analysis. Waste Management and Research 36:48–58. https://doi.org/10.1177/0734242X17739972
Directive EC (2008) Directive 2008/98/EC of the European Parliament and of the Council of 19 November 2008 on waste and repealing certain Directives, Official Journal of the European Union L 312(3)
Eker HH, Bilgili MS (2011) Statistical analysis of waste generation in healthcare services: a case study. Waste Management and Research 29:791–796. https://doi.org/10.1177/0734242X10396755
Eleyan D, Al-Khatib IA, Garfield J (2013) System dynamics model for hospital waste characterization and generation in developing countries. Waste Management and Research 31:986–995. https://doi.org/10.1177/0734242X13490981
Farooq MT, Omar N, Shahid F, Khizar S, Khan A, Manzoor AN, I, (2017) Assessment of hospital waste management protocols in tertiary care hospitals of Lahore. Biomedica 33(2):136–143. https://doi.org/10.4103/tmj.tmj_19_17
Franzosi F, Kist LT, Moraes JAR, Machado ÊL (2018) Diagnosis of the health care waste management system of hospitals in the west of Santa Catarina State-Brazil. Produccion y Limpia 13(1):54–64. https://doi.org/10.22507/pml.v13n1a5
Gomes SCS, Mendonça IV dos S, Oliveira LP and Caldas, Ade JM (2019) Workplace accidents among hospital cleaning professionals at a hospital in the city of Maranhão, Brazil. Ciencia e Saude Coletiva 24(11). https://doi.org/10.1590/1413-812320182411.26752017
Golbaz S, Nabizadeh R, Sajadi HS (2019) Comparative study of predicting hospital solid waste generation using multiple linear regression and artificial intelligence. J Environ Health Sci Eng 17:41–51. https://doi.org/10.1007/s40201-018-00324-z
Hossain MS, Santhanam A, Nik Norulaini NA, Omar AKM (2011) Clinical solid waste management practices and its impact on human health and environment - a review. Waste Manage 31(4):754–766. https://doi.org/10.1016/j.wasman.2010.11.008
Idowu I, Alo B, Atherton Wand Al Khaddar R (2013) Profile of medical waste management in two healthcare facilities in Lagos, Nigeria: a case study. Waste Management and Research 31(5). https://doi.org/10.1177/0734242X13479429.
International Committee of the Red Cross (2011) Medical waste management.
Khan BA, Cheng L, Khan AA, Ahmed H (2019) Healthcare waste management in Asian developing countries: a mini review. Waste Manage Res 37(9):863–875. https://doi.org/10.1177/0734242X19857470
Klangsin P, Harding AK (1998) Medical waste treatment and disposal methods used by hospitals in Oregon, Washington, and Idaho. Journal of the Air and Waste Management Association, 48(60). https://doi.org/10.1080/10473289.1998.10463706.
Liao CJ, Ho CC (2014) Risk management for outsourcing biomedical waste disposal - using the failure mode and effects analysis. Waste Management, Elsevier Ltd 34(7):1324–1329. https://doi.org/10.1016/j.wasman.2014.03.007
Maders GR, Cunha HFA (2015) Análise da gestão e gerenciamento dos resíduos de serviços de saúde (RSS) do Hospital de Emergência de Macapá, Amapá. BrasilEngenharia Sanitária e Ambiental 20:379–388. https://doi.org/10.1590/S1413-41522015020000137607
Marinković N, Vitale K, Holcer NJ, Džakula A, Pavić T (2008) Management of hazardous medical waste in Croatia. Waste Manage 28(6):1049–1056. https://doi.org/10.1016/j.wasman.2007.01.021
Mensoor MK (2020) Medical waste management in Iraq: a case study of BaghdadWaste Disposal & Sustainable. Energy 2(4):329–335
Minoglou M, Gerassimidou S, Komilis D (2017) Healthcare waste generation worldwide and its dependence on socio-economic and environmental factors, Sustainability (Switzerland), 9(2). https://doi.org/10.3390/su9020220.
Nemathaga F, Maringa S, Chimuka L (2008) Hospital solid waste management practices in Limpopo Province, South Africa: a case study of two hospitals. Waste Management 28(7). https://doi.org/10.1016/j.wasman.2007.03.033.
Olaniyi FC, Ogola JS, Tshitangano TG (2019) Efficiency of health care risk waste management in rural healthcare facilities of South Africa: an assessment of selected facilities in Vhembe District Limpopo Province. International Journal of Environmental Research and Public Health 16(12):2199
Patwary MAO, Hare WT, Street G, Maudood Elahi K, Hossai SS, Sarker MH (2009) Quantitative assessment of medical waste generation in the capital city of Bangladesh. Waste Management Elsevier Ltd 29(8):2392–2397. https://doi.org/10.1016/j.wasman.2009.03.021
Pépin J, Chakra CNA, Pépin E, Nault V, Valiquette L (2014) Evolution of the global burden of viral infections from unsafe medical injections, 2000–2010. PLoS ONE 9(6):1–8. https://doi.org/10.1371/journal.pone.0099677
Prüss-Üstün A, Rapiti E, Hutin Y (2005) Estimation of the global burden of disease attributable to contaminated sharps injuries among health-care workers. American Journal of Industrial Medicine, Wiley Online Library 48(6):482–490
Prüss-Üstün A, Townend WK et al (1999) Safe management of wastes from health-care activities World Health Organization.
Ramos HMP, Cruvinel VRN, Galato D (2016) The impact of health services, waste to public health and to the environment, in Waste Management and. The Environment VIII. https://doi.org/10.2495/wm160231.
Ream PSF, Tipple AFV, Barros DX, Souza ACS, Pereira MS (2016) Biological risk among hospital housekeepers. Archives of Environmental and Occupational HealthTaylor & Francis 71(2):59–65. https://doi.org/10.1080/19338244.2014.927347
Scarponi CF de O, Zolnikov TR, Mol MPG (2019) Are waste pickers at risk for hepatitis b and c infections because of poverty or environmental exposures?, Revista da Sociedade Brasileira de Medicina Tropical 52.https://doi.org/10.1590/0037-8682-0123-2019
Schneider VE, Manfredini KLand Paiz, JC (n.d.) Evaluation of the contents of waste generation of health care in a hospital school, pp 1–6
Solberg KE (2009) Trade in medical waste causes deaths in India. Lancet 373(9669):p1067. https://doi.org/10.1016/S0140-6736(09)60632-2
Tabasi, Rand Marthandan G (2013) Clinical waste management : a review on important factors in clinical waste generation rate. Int J Sci Technol
Tesfahun E, Kumie A, Beyene A (2016) Developing models for the prediction of hospital healthcare waste generation rate. Waste Manag Res 34(1):75–80. https://doi.org/10.1177/0734242X15607422
Tesfahun E, Kumie A, Legesse W, Kloos HB, A, (2014) Assessment of composition and generation rate of healthcare wastes in selected public and private hospitals of Ethiopia. Waste Manage Res 32(3):215–220. https://doi.org/10.1177/0734242X14521683
Tudor TL (2007) Towards the development of a standardised measurement unit for healthcare waste generation. Resources, Conservation and Recycling, Elsevier 50(3):319–333. https://doi.org/10.1016/j.resconrec.2006.06.007
Vaccari M, Tudor T, Perteghella A (2018) Costs associated with the management of waste from healthcare facilities: an analysis at national and site level. Waste Manag Res 36:39–47. https://doi.org/10.1177/0734242X17739968
Weiss A, Hollandsworth HM, Alseidi A, Scovel L, French C, Derrick EL, Klaristenfeld D (2016) Environmentalism in surgical practice. Current Problems in Surgery, Elsevier 53(4):165–205. https://doi.org/10.1067/j.cpsurg.2016.02.001
WHO (2015) Status of health-care waste management in selected countries of the Western Pacific Region. WHO Regional Office for the Western Pacific, Manila
WHO (2018) Health-care waste Available at: https://www.who.int/en/news-room/fact-sheets/detail/health-care-waste (Accessed: 19 March 2020)
Windfeld ES, Brooks MSL (2015) Medical waste management - a review. Journal of Environmental Management Elsevier Ltd 163:98–108. https://doi.org/10.1016/j.jenvman.2015.08.013
World Health Organization (WHO) (2014) Safe management of wastes from health-care activities, World Health Organization.
Zajac, M, Fernandes, R, David, C, Aquino S (2016) Logística Reversa de Resíduos da Classe D em Ambiente Hospitalar: Monitoramento e Avaliação da Reciclagem no Hospital Infantil Cândido FontouraRevista Gestão Ambiental e Sustentabilidade 5, 78–93https://doi.org/10.5585/geas.v5i1.326
Zolnikov TR, Ramirez-Ortiz D, Moraes H, Nogueira VRC, Dominguez A, Galato D (2019) Continued medical waste exposure of recyclable collectors despite dumpsite closures in Brazil, Journal of Health and Pollution, 9(23). https://doi.org/10.5696/2156-9614-9.23.190905.
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The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: financial support provided by Fundação de Amparo à Pesquisa do Estado de Minas Gerais (FAPEMIG) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq).
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Conception and design, MPGM. Review methodology, ACN, GRS, JLLT, and MPGM. Data analysis, ACN, GRS, JLLT, TRZ, and MPGM. Manuscript drafting, ACN and MPGM. Manuscript revision, TRZ, RTVB, MPGM, and LH. Final version approval of the manuscript, all authors.
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Mol, M.P.G., Zolnikov, T.R., Neves, A.C. et al. Healthcare waste generation in hospitals per continent: a systematic review. Environ Sci Pollut Res 29, 42466–42475 (2022). https://doi.org/10.1007/s11356-022-19995-1
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DOI: https://doi.org/10.1007/s11356-022-19995-1