ABSTRACT
La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)
Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)
Subject(s)
Humans , Male , Adolescent , Adult , Occupational Risks , Health Knowledge, Attitudes, Practice , Medical Waste Disposal , Waste Management/methods , Environmental Hazards , Peru , Cross-Sectional Studies , Surveys and Questionnaires , Health Personnel , HospitalsABSTRACT
Abstract Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.
Resumo Hospitais e outros centros de tratamento de saúde geram um volume de resíduos cada vez maior, dos quais cerca de 15% podem ser infecciosos, tóxicos ou radioativos. A Organização Mundial da Saúde começou a enfrentar o problema na década de 1980. Inicialmente, concentrou-se nos países ricos, depois mudou o foco para os países pobres, onde métodos de eliminação inseguros, como aterros sanitários e incineradores inadequados, preocupavam. Aos poucos, a compreensão do problema passou por mudanças, inclusive do enfoque no conteúdo do resíduo hospitalar considerado "perigoso", passando para todas as formas de resíduos, e da aceitação do resíduo médico como um inconveniente inerente aos cuidados de saúde de alta qualidade, até o conceito de que evitar a produção de resíduos hospitalares faz parte dos cuidados de saúde de alta qualidade.
Subject(s)
History, 20th Century , History, 21st Century , Waste Management/history , Health Facility Administration/history , Medical Waste/history , Waste Management/methods , Health Facilities/historyABSTRACT
Background: Health care waste (HCW) is unwanted materials produced from hospitals, laboratories and research centres. HCW is of public health importance because hazardous HCW carries significant health risks. If poorly handled, it can lead to significant public health crises. Consequently, guidelines for proper management of HCW have been legislated. Unfortunately, not all healthcare facilities adhere to the guidelines. Diseases spread by inadequately disposed HCW are becoming increasingly prevalent especially in developing nations. This study was therefore conducted to establish the status of HCW management in six purposefully selected healthcare facilities in Nakuru East Sub-County (NESC), Kenya.Methods: A cross sectional study design was used to conduct this study. Six healthcare facilities (HCFs) in NESC, Kenya were purposefully selected. The HCFs were selected based on level and patient volumes and categorised as small or medium sized. HCW from each of the HCFs was weighed and categorised. Observation checklists and interviews were used to determine techniques used in HCW management.Results: The total weekly weight of HCW was 187.65 kg (mean 31.3 kg). Small sized HCF produced 49.55 kg/week while medium sized HCFs produced 138.1 kg/week. Total weekly weight of general HCW was 143.7 kg (76.5%); 33.8 kg (18%) was infectious while 10.2 kg (5.4%) was sharps.Conclusions: Healthcare facilities in NESC produce significant quantities of HCW. General HCW was predominant, followed by infectious waste and sharps. A considerable proportion of the HCFs did not comply with the stipulated guidelines for safe management of HCW. Concerned authorities in all HCFs should be alert and proactive regarding proper management of HCW.
ABSTRACT
Resumo Para compreender a complexa relação entre o campo ambiental e o da saúde é indispensável o uso de indicadores. Para propor os de Saúde Ambiental, o Ministério da Saúde recomenda um Modelo proposto pela OMS. Este, denominado Modelo FPSEEA, é composto pelos elementos: Força Motriz, Pressão, Situação, Exposição, Efeito, Ações. O objetivo deste artigo é propor a aplicação deste Modelo no Gerenciamento dos Resíduos de Serviço de Saúde (RSS). Trata-se de pesquisa documental utilizando duas fontes de dados: a) relatórios técnicos de pesquisas sobre RSS dos últimos 15 anos (ambulatorial, odontológico, hospitalar, veterinário, universitário e de UBS) na Universidade de Caxias do Sul; b) Manual do MS "Saúde Ambiental: guia básico para construção de indicadores". Os resultados evidenciam que o Modelo é relevante por permitir analisar determinado contexto, propor indicadores e definir ações específicas para, no caso deste estudo, monitorar e aprimorar formas de manejo dos RSS. Evidenciam, ainda, que o modelo proposto constitui uma importante ferramenta de análise, tanto na MWM, como no planejamento de ações que minimizem os riscos, especialmente biológicos e químicos, resultando em saúde e proteção do ambiente.
Abstract The use of health indicators is indispensable for understanding the complex relationship between the environmental and health fields. For the proposition of environmental health indicators, the Brazilian Ministry of Health (MH) recommends using a model proposed by the World Health Organization. This model is composed of the following elements: Driving Force, Pressure, State, Exposure, Effect, and Action; it is called the DPSEEA model. The objective of this study is to propose the application of this model in healthcare waste (HCW) management. This study was performed by documentary research using two data sources: a) technical reports on research on HCW from the last 15 years (outpatient, dental, hospital, veterinary, university, and primary care unit) at the University of Caxias do Sul, Brazil; and b) the MH manual entitled "Environmental Health: Basic Guide for the Construction of Indicators". The results show that the model is relevant because it makes it possible to analyse a particular context, proposing indicators and defining specific actions for the case of this study, to monitor and improve methods of managing HCW. The results also show that the proposed model is an important analytical tool for both medical waste management and planning actions that will minimize risks, particularly chemical and biological, resulting in environmental health and protection.
Subject(s)
Humans , Environmental Health , Waste Management/methods , Models, Theoretical , World Health Organization , Brazil , Health Status IndicatorsABSTRACT
Abstract This meta-analysis, which is based on a previously published systematic review, aims to contribute to the scientific discussion on hepatitis B virus (HBV) infection in workers who are exposed to domestic and healthcare wastes. Publications were sought which had been made available on the data used by December 2013 and updated to December 2016. The quality of the included studies was assessed according to the guidelines of Loney et al. for the critical appraisal of studies on the prevalence or incidence of a health problem. To verify the presence of heterogeneity between the papers, we used the Chi-squared test based on a Q statistic. A funnel plot was used to test for publication bias. All included studies had across-sectional study design. The association between exposure to waste and positive serology for the HBV surface antigen (HBsAg) showed a significant association [odds ratio (OR) 1.89, 95% confidence interval (CI) 1.27-2.86; p = 0.0019]. The prevalence rates of HBsAg and anti-HBc seropositivity was 0.04 (95% CI 0.03-0.05) and 0.21 (95% CI 0.14-0.28), respectively (p <0.0001). We found no evidence of publication bias. The results of this meta-analysis indicate a statistically significant association between exposure to solid waste, whether healthcare or domestic, and positive HBV infection markers. Therefore, the working conditions of waste collectors should be analyzed more closely. Immunization against HBV is recommended as the chief preventive measure for all solid waste workers.
Subject(s)
Humans , Occupational Exposure/statistics & numerical data , Medical Waste Disposal , Waste Management , Hepatitis B/transmission , Occupational Diseases/etiology , Risk FactorsABSTRACT
RESUMO Esta pesquisa teve como objetivo levantar a geração de Resíduos de Serviços de Saúde (RSS) em hospitais do município de Ribeirão Preto (SP). Trata-se de um estudo descritivo e exploratório, desenvolvido em 11 hospitais do município. Os dados foram coletados por meio da pesagem dos RSS e foram analisados por meio da estatística descritiva. A coleta de dados foi iniciada após autorização dos hospitais e aprovação pelo Comitê de Ética em Pesquisa (CEP) da Escola de Enfermagem de Ribeirão Preto da Universidade de São Paulo (EERP/USP). Os 11 hospitais incluídos no estudo apresentaram uma geração de 44.489,91 kg de RSS em seis dias de coleta, com uma média diária de 7.414,98 kg.dia-1. Os dados obtidos revelaram uma geração de 29.846,08 kg (67,1%) de resíduos comuns (Grupo D) e de 11.236,69 kg (25,3%) de resíduos infectantes e perfurocortantes (Grupos A e E, respectivamente). Este estudo reforça a necessidade de um gerenciamento adequado de RSS para a redução da geração em qualquer situação, especialmente em hospitais.
ABSTRACT This research aimed to identify the generation of healthcare waste in hospitals in the city of Ribeirão Preto (SP). This is a descriptive and exploratory study conducted in 11 hospitals in the city. Data were collected through of the weighing of the MW and were analyzed using descriptive statistics. Data collection was initiated after approval of hospitals and approval by the of Ethics Committee Research of the EERP/USP. The 11 hospitals included in the study had a generation of 44,489.91 kg of healthcare waste at 6 days, with a daily average of 7,414.98 kg.day-1. The data obtained revealed a generation of 29,846.08 kg (67.1%) of common residues (Group D); and 11,236.69 kg (25.3%) of infectious waste and sharps (Groups A and E). This study reinforces the need for adequate healthcare waste management for the reduction of generation in any situation, especially in hospitals.
ABSTRACT
Objective: To assess healthcare workers' involvement in healthcare waste management in public and private hospitals. Methods: Validated questionnaires (n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013. Results: Among the healthcare workers that participated in the study, 187 (28.33%) were medical doctors, 44 (6.67%) were pharmacists, 77 (11.67%) were medical laboratory scientist, 35 (5.30%) were waste handlers and 317 (48.03%) were nurses. Generally, the number of workers that have heard about healthcare waste disposal system was above average 424 (69.5%). More health-workers in the government (81.5%) than in private (57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it. The level of waste generated by the two hospitals differed significantly (P = 0.008. 6) with the generation level higher in government than private hospitals. The materials for healthcare waste disposal were significantly more available (P = 0.001) in government than private hospitals. There was no significant difference (P = 0.285) in syringes and needles disposal practices in the two hospitals and they were exposed to equal risks (P = 0.851. 0). Fifty-six (18.5%) and 140 (45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste management committee with 134 (44.4%) and 19 (6.2%) workers confirming that it did not exist in their institutions. The existence of the committee was very low in the private hospitals. Conclusions: The availability of material for waste segregation at point of generation, compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.
ABSTRACT
Objective: To assess healthcare workers' involvement in healthcare waste management in public and private hospitals. Methods: Validated questionnaires (n = 660) were administered to randomly selected healthcare workers from selected private hospitals between April and July 2013. Results: Among the healthcare workers that participated in the study, 187 (28.33%) were medical doctors, 44 (6.67%) were pharmacists, 77 (11.67%) were medical laboratory sci-entist, 35 (5.30%) were waste handlers and 317 (48.03%) were nurses. Generally, the number of workers that have heard about healthcare waste disposal system was above average 424 (69.5%). More health-workers in the government (81.5%) than in private (57.3%) hospitals were aware of healthcare waste disposal system and more in government hospitals attended training on it. The level of waste generated by the two hospitals differed significantly (P = 0.0086) with the generation level higher in government than private hospitals. The materials for healthcare waste disposal were significantly more available (P = 0.001) in government than private hospitals. There was no significant difference (P = 0.285) in sy-ringes and needles disposal practices in the two hospitals and they were exposed to equal risks (P = 0.8510). Fifty-six (18.5%) and 140 (45.5%) of the study participants in private and government hospitals respectively were aware of the existence of healthcare waste man-agement committee with 134 (44.4%) and 19 (6.2%) workers confirming that it did not exist in their institutions. The existence of the committee was very low in the private hospitals. Conclusions: The availability of material for waste segregation at point of generation, compliance of healthcare workers to healthcare waste management guidelines and the existence of infection control committee in both hospitals is generally low and unsatisfactory.
ABSTRACT
A Norma Técnica CETESB P2.111/2007 foi tomada como base para avaliar a desinfecção de resíduos de serviços de saúde (RSS) por micro-ondas, através da comparação dos resultados provenientes da utilização da norma, ou seja, com endósporos de Bacillus atropheus em suspensão no interior de ampolas introduzidas nos RSS, com os obtidos nos endósporos dispersos na superfície das partículas. Os resultados foram ajustados à cinética de primeira ordem e à Lei de Arrhenius para obtenção das energias de ativação (Ea) e dos fatores pré-exponenciais (k0). A Ea obtida nos endósporos em suspensão nas ampolas (99-45 J.mol-1) foram sensivelmente menores quando comparadas com as Ea (9.203-5.782 J.mol-1) provenientes da inativação dos endósporos dispersos sobre os RSS, para k0 praticamente constantes (0,26 e 0,23 min-1, respectivamente). Portanto, a resistência à inativação dos endósporos foi bastante afetada pelo meio suporte utilizado, tendo sido mais sensíveis à exposição a micro-ondas no meio líquido do que no meio sólido.
The Technical Standard CETESB P2.111/2007 was tested to evaluate the microwave healthcare waste disinfection, by comparing the results obtained using the standard procedure, i.e. Bacillus atropheus spores in suspension inside vials distributed in the waste, with those obtained with spores dispersed on the particles surface. The experimental results were adjusted based on first-order kinetic model and Arrhenius Law to determine the activation energies (Ea) and the pre-exponential factors (k0). The Ea in spores suspension inside vials (99-45 J.mol-1) were significantly lower when compared with Ea (9,203-5,782 J.mol-1) from the inactivation of dispersed spores in the waste to k0 practically constant (0.26 and 0.23 min-1, respectively). Therefore, spore resistance to inactivation was greatly affected by the support medium used, since the spores were more susceptible to microwave exposition in liquid medium than in the solid one.
ABSTRACT
Nesta pesquisa, quantificam-se e classificam-se, conforme a Resolução RDC ANVISA nº 306/2004, os Resíduos de Serviço de Saúde do Grupo A, gerados em seis hospitais de Vitória (ES), Brasil. Os resíduos acondicionados sem segregação foram separados por grupos e subgrupos, resultando em: 57% do Grupo D - comum; 41% do Grupo A - risco biológico; 1,5% do Grupo B - risco químico e 0,05% do Grupo E - perfuro-cortantes. O peso específico aparente foi de 106,2 kg.m-3 e a taxa média de geração de resíduos foi 2,68 kg.(leito.ocupado.dia)-1. Ao se segregar os resíduos do Grupo D, a taxa de geração do Grupo A passou a ser 1,15 kg.(leito.ocupado.dia)-1, resultando em 58% de redução nos custos com incineração. Com a segregação dos Grupos B, D, E e do subgrupo A4, a taxa de geração passou a ser 0,18 kg.(leito.ocupado.dia)-1, com uma redução nos custos com incineração de 93%.
In this research the Health Care Waste of Group A (Resíduos de Serviço de Saúde - RSS), collected from six hospitals in Vitoria (ES), Brazil, was quantified and classified according with ANVISA's Resolution RDC nº 306/2004. The waste was packaged without segregation and afterwards separated by groups and subgroups, with the following results/percentages: 57% Group D - common; 41% Group A - biological risk; 1.5% Group B - chemical risk; and 0.05% Group E - sharps. The apparent bulk density was 106.2 kg/m3. The average production rate of this mixture was 2.68 kg per occupied bed daily. By separating the mixture of the RSS from group D, the average production rate of Group A changed to 1.15 kg per occupied bed daily, reducing incineration costs by 58%. By segregating Groups B, D, E and subgroup A4, the average production rate changed to 0.18 kg per occupied bed per day with a reduction of 93% in incineration costs.
ABSTRACT
Nesta pesquisa focou-se o gerenciamento dos resíduos de serviços de saúde (RSS) e especificamente aqueles do tipo perfurocortantes. Foram analisadas as formas atuais de gestão implementadas na bacia hidrográfica do Rio dos Sinos (BHRS), a partir da aplicação de questionários nos estabelecimentos de saúde geradores de RSS. Os resultados indicam que 48,6% dos estabelecimentos de saúde atendem corretamente à legislação específica brasileira, verificando ainda uma melhor gestão para os estabelecimentos privados. Os estabelecimentos de saúde do tipo "laboratórios, bancos de sangue e farmácias" instalados nos municípios com mais de 20.000 habitantes e área municipal na BHRS dentro da faixa de 80 a 100% em relação à área total municipal apresentaram os piores resultados em termos de gestão de RSS. O grupo de atividades de serviços de saúde com o maior número de estabelecimentos na BHRS - "consultórios/clínicas de odontologia, clínicas veterinárias, drogarias e unidade móvel" - indicou um dos menores índices de conhecimento das exigências legais específicas relativas ao tema estudado.
This research focused on the management of healthcare waste, specifically about the sharps types. The current ways of management in the Rio dos Sinos basin (BHRS) were analyzed with the use of questionnaires in health establishments generators of healthcare waste. The results indicate that 48.6% of health facilities comply with the specific legislation in Brazil, also indicating a better management coming from private institutions. Health facilities of the type "labs, blood banks and pharmacies" installed in municipalities with over 20,000 inhabitants and municipal area in BHRS within the range of 80 to 100% relative to the total municipal area had the worst results in terms of healthcare waste management. The group activities of healthcare services with the highest number of establishments in BHRS - "dental offices/clinics, veterinary clinics, drugstores and mobile health units" - indicated one of the lowest levels of knowledge about specific legal requirements relating to the theme.
ABSTRACT
O presente trabalho propôs um modelo de avaliação do gerenciamento de RSS em estabelecimentos de saúde, com o uso de indicadores de desempenho. A proposta consistiu em identificar esses indicadores a partir dos dados qualitativos obtidos por entrevistas, cujas respostas foram associadas a escalas numéricas e inseridas no programa Statistica (StatSoft®) para efetuar a análise fatorial (AF). Para isso, foi elaborado um roteiro de entrevista, especialmente preparado com 29 variáveis de observação e aplicado a 98 profissionais da saúde da Santa Casa de Misericórdia de São Carlos (SP). Os indicadores de desempenho foram submetidos ao julgamento de especialistas para a sua classificação em ordem de importância, com o uso da matriz de avaliação do método AHP (Analytic Hierarchy Process). Por fim, foi composto um índice global, que possibilitou a avaliação geral da situação investigada, em uma escala de zero a um, indicando que ações de melhoria para esse gerenciamento devem ser desenvolvidas. Este trabalho foi desenvolvido a fim de estruturar um modelo de avaliação de desempenho por meio da identificação de indicadores qualitativos, auxiliando na eficiência do processo de gerenciamento de resíduos em ambientes de saúde.
This paper proposed a model of evaluation of healthcare waste (HW) management in health establishments by the use of performance indicators. It was structured to identify these indicators by qualitative data obtained from interviews. The answers were associated to a numerical scale and were inserted in Statistica program (StatSoft®) to calculate the factor analysis (FA). A script of interview containing 29 observation variables was especially prepared and applied to 98 health professionals of Santa Casa de Misericórdia de São Carlos, São Carlos (SP), Brazil. Performance indicators were evaluated by experts who ordered them in terms of importance using Analytic Hierarchy Process (AHP) method. Finally, it was composed a global index that allowed the general evaluation of the analyzed situation, in a scale from zero to one, pointing to the actions of improvement to this management. This paper was developed in order to elaborate a model of performance evaluation by the identification of qualitative indicators, promoting an efficient waste management process in health environment.
ABSTRACT
Resíduos de serviços de saúde da cidade de Ribeirão Preto - SP, previamente esterilizados em autoclave, foram inoculados com microrganismos da espécie P. aeruginosa na forma vegetativa para o processamento com microondas em escala de laboratório. Analisou-se a influência do tempo de exposição à radiação (25, 30, 35 e 40 min.) e da potência por unidade de massa de resíduo (60, 80 e 100 W/kg) no percentual de inativação dos microrganismos para a umidade de entrada do resíduo de 50 por cento em base úmida. Os resultados experimentais foram ajustados com base na cinética de primeira ordem para determinação da energia de ativação (no intervalo de 13,9 a 14,1 kJ/mol) e do fator pré-exponencial da lei de Ahrrenius (10,7 min-1) pelo método dos mínimos quadrados. As equações propostas permitiram obter por simulação a constante cinética e estimar o tempo de processamento necessário para fornecer diferentes níveis de inativação. Por exemplo, o tempo de exposição à radiação de 117 min foi requerido para se obter o nível de inativação 6.Log 10 para os resíduos processados à 100 W/kg e à temperatura de 100ºC.
Public healthcare wastes from the city of Ribeirão Preto-SP, pre-sterilised in an autoclave, were inoculated with microrganisms of the species P. aeruginosa in vegetative form for microwave processing on a laboratory scale. An analysis was made of the influence of radiation exposure time (15, 25, 30 and 40 min) and power per waste mass unit (60, 80 and 100 W/kg) on the percentage of inactivation of the microrganisms at an incoming waste moisture level of 50 percent (wet basis). The experimental results were adjusted based on first-order kinetic model. The activation energies (in the range of 13.9 to 14.1 kJ/mol) and the Arrhenius pre-exponential factors (10.7 min-1) were determined by the least squares method. The kinetic parameters obtained allow one to predict by simulation the first-order kinetic constant achieved with P. aeruginosa in typical healthcare waste, based on the radiation exposure time and temperature for some levels of inactivation. For example, the waste disinfection time required for the inactivation level equivalent to 6.Log10 was estimated to 117 min for wastes processed at 100 W/kg and at temperatures of 100ºC.