Hospital waste: can we reduce the environmental impact of a large university hospital?

Introduction: As technology advances, society must reflect on the destination of materials which are no longer needed. Hospital waste requires special attention due to the associated risk of disease transmission and biological accidents. Also, it tends to increase proportionally to the economic development and is associated with increased use of disposable material. The purpose of this study is to analyze the management of hospital waste at the Hospital de Clínicas de Porto Alegre (HCPA) and to evaluate the effectiveness and feasibility of the measures adopted by the institution to mitigate the impact of its waste on the environment. Methods: Observational study with field research. Hospital waste management is divided into generation, disposal, storage and final destination. Results: Between 2010 and 2015, the HCPA produced 21.4 tons of biological and sharps waste, 23,000 liters of chemical waste and 113,9 tons of solid waste per month. The main improvements include the implementation of a inspection of the hospital's waste bins every 2 months, a reduction from 29.42% to 2.79% in the rate of inappropriate disposal of hazardous waste, a 313% increase in investments in staff training, the expansion and adaptation of external areas for temporary storage of hospital waste and the collection of more than 1 ton of waste generated by the local community (sharps, X-ray films, kitchen oil, batteries), as well as the establishment of contracts which will guarantee the appropriate treatment of all types of health care waste. Conclusions: These results demonstrate that mitigating the impact of hospital waste on the environment is possible and should encourage the adoption of similar measures at other institutions (AU)

Qualidade em serviços públicos: os desafios da atenção primária / Quality in public services: the challenges of primary care / Servicios públicos: los desafíos de la Atención Primaria

O Ministério da Saúde brasileiro sinalizou uma política de avaliação da qualidade da Atenção Primária através da portaria 1.654, de 19/07/2011. Toda mudança organizacional interfere na cultura de qualquer instituição, especialmente quando esta mudança está direcionada para o tema da qualidade. Ela envolve processos, meios internos e pessoas, e não pode ser artificialmente produzida pela força da caneta. No setor saúde, a gestão baseada na qualidade envolve mudanças de foco de atuação e de tecnologias, apoiadas no resgate da relação profissional-paciente, na forma de remuneração de médicos e equipes, na qualificação e capacitação dos profissionais, na qualificação da própria gestão e na participação ativa dos profissionais da saúde na pactuação destas metas e parâmetros de qualidade. Outros instrumentos de avaliação da qualidade já foram implantados no âmbito da Atenção Primária no subsistema público de saúde, e seu seguimento foi interrompido. Qualificar a Atenção Primária passa não apenas pela avaliação, mas pela seleção de profissionais capacitados, qualificação da prestação de serviços, monitorização de resultados e valorização dos profissionais de saúde envolvidos com a nova cultura.

The Brazilian Ministry of Health has signaled a policy of evaluating the quality of primary care through the 1654 decree of 19.07.2011. Any organizational change interferes with the culture of any institution, especially when this change is directed toward the issue of quality. It involves processes, internal resources and people, and cannot be artificially produced by the power of the pen. In the health sector, management based on quality involves changes in business focus and technology, supported the rescue of professional-patient relationship, in the form of compensation of physicians and teams, in the qualification and training of professional, in qualifications in their own management, and in active participation of health professionals in the Agreement on these goals and quality parameters. Other instruments of quality assessment have been established within the Primary Care in public health sub-system, and its follow-up was interrupted. Qualifying the Primary is not just about evaluation, but also the selection of qualified professionals, qualification of services, monitoring results and valuation of health professionals involved with the new culture.

El Ministerio de Salud de Brasil ha dado señales de una política de evaluación de la calidad de la atención primaria a través del decreto 1654 de 19.07.2011. Cualquier cambio en la organización interfiere con la cultura de cualquier institución, sobre todo cuando este cambio se dirige hacia el tema de la calidad. Implica en procesos internos, recursos y personas, y no puede ser producido artificialmente por el poder de la pluma. En el sector de la salud, la administración basada en la gestión de calidad implica en cambios en el enfoque de negocio y la tecnología apoyada en lo rescate de la relación profesional-paciente, en la forma de compensación de equipos y médicos, en la cualificación y formación de los profesionales, en la cualificación en su propia gestión y en la participación activa de profesionales de la salud en el acuerdo sobre los objetivos y parámetros de calidad. Otros instrumentos de evaluación de la calidad se han establecido dentro de la Atención Primaria en el sistema de salud sub-público, y su seguimiento se interrumpió. La cualificación de la atención primaria no ocurre sólo por la evaluación, pero también por la selección de profesionales cualificados, la calificación de servicios, lo seguimiento de los resultados y la valoración de los profesionales de la salud involucrados con la nueva cultura.