Waste management practices among dental surgery staff of major hospitals in Accra: a descriptive cross-sectional study

Introduction: the practice of dentistry in contemporary times produces considerable waste that could be harmful to individuals and the environment at large. In Ghana and many other jurisdictions, there are guidelines that outline how these wastes should be managed. This study was conducted to explore practices concerning dental waste management among dental surgery staff in some public facilities in Accra, Ghana. Methods: a descriptive cross-sectional study involving dental surgery staff of four major facilities in Accra was done. Overall, 124 staff from the selected facilities participated in the study, and 51 different dental surgeries were assessed. Data were collected using a structured questionnaire and an observation checklist. The questionnaire included questions on socio-demographics, as well as knowledge and practices regarding dental waste management. Results: there was unsatisfactory knowledge of waste disposal, while practices did not generally meet international recommendations and the Ministry of Health´s (MOH) guidelines. Though all respondents stored their sharp waste in puncture-proof containers, 98.4% did not label their clinical waste, while 62.9% would dispose of used X-ray fixers by pouring them down the drain. None of the 51 surgeries observed had more than one colour code available. Conclusion: there is a palpable need for education, monitoring, and empowerment concerning waste management in Ghana´s oral healthcare system.

Impacto de una intervención educativa en el conocimiento y manejo de residuos peligrosos biológico-infecciosos / Impact of an educational intervention on the knowledge and management of infectious biological hazardous waste

Introducción: el personal de enfermería tiene una participación fundamental en el manejo de los residuos peligrosos biológico-infecciosos (RPBI) durante la atención en salud, situación que hace indispensable el conocimiento respecto a la peligrosidad y riesgo en el manejo de estos residuos. Objetivo: evaluar el impacto de una intervención educativa acerca del conocimiento y manejo de RPBI, en el personal de enfermería de un hospital general regional. Metodología: estudio cuasi experimental, pretest/postest, prospectivo y longitudinal. Se realizó una intervención educativa, y antes y después de esta se aplicó un cuestionario para evaluar conocimientos relacionados con RPBI y una lista de cotejo del Modelo Institucional para la Prevención de Infecciones Nosocomiales (MIPRIN) para evaluar el manejo de RPBI. Resultados: la intervención educativa demostró un efecto positivo en los conocimientos del personal de enfermería en relación con el manejo de RPBI. En la evaluación pretest se obtuvo un porcentaje de conocimientos de 65.2% y en la postest fue de 78.3% (p < 0.001). Respecto al cumplimiento en el manejo de RPBI, hubo un incremento; sin embargo, no se puede atribuir a la intervención, puesto que se evaluó por servicio y no de manera directa con los participantes. Conclusión: la intervención educativa mostró cambios significativos en los conocimientos y el manejo de RPBI del personal de enfermería.

Introduction: Nursing staff represent an important percentage in the management of biological hazardous waste (BHW) during health care, a situation that makes this knowledge essential regarding the danger and risk in handling these wastes. Objective: To evaluate the impact of an educational intervention about the knowledge and management of BHW in the nursing staff of a regional general hospital. Methods: quasi-experimental, pre-test/post-test, prospective and longitudinal study. An educational intervention was carried out; before and after this intervention, a questionnaire was administered to evaluate knowledge related to BHW and a checklist of the Institutional Model for the Prevention of Nosocomial Infections (MIPRIN, according to its initials in Spanish) to evaluate the management of BHW. Results: The educational intervention showed a positive effect in the nursing staff's knowledge in relation to BHW. In the pre-test evaluation a knowledge percentage of 65.2% was obtained and in the post-test evaluation it was 78.3% (p < 0.001). Regarding compliance in the management of BHW there was an increase; however, it cannot be attributed to the intervention, since it was evaluated by service and not directly with the participants.

Laboratory chemical waste: hazard classification by GHS and transport risk / Resíduos químicos laboratoriais: classificação de perigo pelo GHS e risco no transporte

ABSTRACT OBJECTIVES: To identify and evaluate, based on the Globally Harmonized System of Classification and Labelling of Chemicals (GHS) and the legislation of the Agência Nacional de Transportes Terrestres (ANTT - National Agency for Terrestrial Transport), the hazards arising from chemical waste generated in research laboratories in the health area. METHODS: Chemical residues generated in two medical research laboratories of the Faculdade de Medicina da Universidade de São Paulo were inventoried, from November 2017 to April 2019, and classified according to the GHS (hazard statements) and the ANTT transport legislation (risk classes), to determine the dangers coming from the respective substances and mixtures. RESULTS: In total, we identified 40 substances or mixtures with classification by the GHS indicating 36 hazard statements, 27 of which related to human health. According to the legislation established by ANTT, we found 16 cases of hazard associated with flammability, 15 cases related to toxicity and 12 cases related to corrosivity. CONCLUSIONS: Chemical residues generated in the laboratories studied are diversified in terms of their hazard characteristics, implying the possibility of exposure to severe risks to workers, students and the environment. The correct identification of these residues is a primary factor for reducing exposure to risks.

RESUMO OBJETIVOS: Identificar e avaliar, com base no Sistema Globalmente Harmonizado de Classificação e Rotulagem de Produtos Químicos (GHS) e na legislação da Agência Nacional de Transportes Terrestres (ANTT), os perigos provenientes dos resíduos químicos gerados em laboratórios de pesquisa na área de saúde. MÉTODOS: Resíduos químicos gerados em dois Laboratórios de Investigação Médica da Faculdade de Medicina da Universidade de São Paulo foram inventariados, no período de novembro de 2017 a abril de 2019, e classificados conforme o GHS (frases de perigo) e a legislação de transportes da ANTT (classes de risco), para determinação dos perigos provenientes das respectivas substâncias e misturas. RESULTADOS: No total, foram identificadas 40 substâncias ou misturas, cuja classificação pelo GHS indicou 36 frases de perigo, sendo 27 relacionadas à saúde humana. De acordo com a legislação estabelecida pela ANTT, foram encontrados 16 casos de periculosidade associada à inflamabilidade, 15 casos relacionados à toxicidade e 12 casos relativos à corrosividade. CONCLUSÕES: Resíduos químicos gerados nos laboratórios estudados são diversificados quanto a suas características de periculosidade, implicando a possibilidade de exposição a riscos severos aos trabalhadores, aos estudantes e ao ambiente. A correta identificação desses resíduos é fator primordial para diminuição da exposição aos riscos.

Redistributing deaths by ill-defined and unspecified causes on cancer mortality in Brazil

ABSTRACT OBJECTIVE to discuss the impact four different redistribution strategies have on the quantitative and temporal trends of cancer mortality assessment in Brazil. METHODOLOGY This study used anonymized and georeferenced data provided by the Brazilian Ministry of Health (BMoH). Four different approaches were used to conduct the redistribution of ill-defined deaths and garbage codes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed the calculation of region, sex, and cancer type trends. RESULTS Death rates increased considerably in all regions after redistribution. Overall, Elisabeth B. França's and the World Health Organization methods had a milder impact on trends and rate magnitudes when compared to the Global Burden of Disease (GBD) 2010 method. This study also observed that, when the BMoH dealt with the problem of redistributing ill-defined deaths, results were similar to those obtained by the GBD method. The redistribution methods also influenced the assessment of trends; however, differences were less pronounced. CONCLUSIONS Since developing a comparative gold standard is impossible, matching global techniques to local realities may be an alternative for methodological selection. In our study, the compatibility of the findings suggests how valid the GBD method is to the Brazilian context. However, caution is needed. Future studies should assess the impact of these methods as applied to the redistribution of deaths to type-specific neoplasms.

Imobilização de metais pesados presentes nos resíduos de quartzito por meio da incorporação em argamassas com substituição total do agregado natural / Immobilization of heavy metals present in quartzite residues through incorporation in mortars with total substitution of the natural aggregate

RESUMO Este trabalho objetivou imobilizar metais pesados presentes nos resíduos de quartzito por meio da incorporação em argamassas em substituição total ao agregado natural. Dois tipos de resíduos foram utilizados: os resíduos de fragmentação das aparas (QS) e os do pó de serragem (QP). Os resíduos foram caracterizados por fluorescência de raios X, difração de raios X e ensaios de toxidade conforme metodologia da Norma Brasileira (NBR) 10005, da NBR 10006 e do Toxicity Characteristic Leaching Procedure (TCLP) 1311. Então, foram analisadas composições de argamassas contendo cimento, cal e os resíduos (QS, QP) utilizando-se a técnica de delineamento de mistura, determinando os melhores traços, o melhor tipo de cura (imersa ou úmida) e, posteriormente, avaliando a resistência dos corpos de prova após cura. A caracterização do resíduo de quartzito revelou a presença de vários metais pesados e extratos lixiviados em contato com a água, classificando-o como resíduo de Classe I — Perigoso. Os resultados indicam que as composições determinadas foram capazes de imobilizar os metais pesados presentes nos resíduos de quartzitos, bem como resultou em argamassas com resistências mecânicas superiores a 2 MPa. Por fim, mostrou-se que essa técnica de solubilização e estabilização dos contaminantes presentes nos resíduos de quartzito é uma alternativa tecnologicamente viável e ambientalmente adequada para a destinação final desses resíduos.

ABSTRACT This work aims to immobilize heavy metals present in the quartzite residues by means of the incorporation in mortars in total substitution to the natural aggregate. Two types of residues were used: quartzite sand (QS) and powder (QP). The residues were characterized by x-ray fluorescence, x-ray diffraction, and toxicity tests according to the methodology of the NBR 10005, 10006 and Toxicity Characteristic Leaching Procedure (TCLP) 1311. Then, compositions of mortar containing cement, lime and residues (QS, QP) were analyzed using technique of designing the mixture, determining the best mixture, the best type of cure (immersed or wet), and subsequently evaluated at resistance of the body of evidences after curing. The characterization of quartzite residue revealed the presence of multiple heavy metals and leached extracts in contact with the water, classifying it a Class I-Hazardous waste. Regarding the production of mortars, the results indicated that the compositions determined were able to immobilize the heavy metals present in the quartzite residues, as well as resulted in mortars with mechanical resistances higher than 2 MPa. Finally, it was shown that this technique of solubilization and stabilization of contaminants present in quartzite residues is a technologically viable and environmentally adequate alternative for the final destination of these residues.

Workers' perception of hazards on recycling sorting facilities in São Paulo, Brazil / Percepção dos trabalhadores quanto aos perigos em centrais de triagem de recicláveis em São Paulo, Brasil

Abstract The paper discusses views, perceptions, experiences, knowledge and behaviors related to occupational risks among recycling workers. Data collection involved field observation and two focus groups in each site. Narratives were recorded, transcribed, and analyzed for themes. Findings are presented according to the following topics: economic and environmental value of recycling; aspects of employment in the cooperative system; occupational hazards; and suggestions of improvements. Municipal programs of selective collection, as implemented in most Brazilian municipalities, still need improvements to achieve their goals and objectives. We learned that organizing recycling workers in cooperatives, despite its broad acceptance as a replacement to informal garbage collection in streets and landfills, only brought small progress regarding the safety and quality of life of cooperative workers. Recycling workers noticed the existence of workplace hazards, but seemed resigned to the situation, considered them as part of the job and did not communicate their needs to supervisors. They ignored the existence of some measures to prevent hazards and sometimes even created work practices and alternatives that endangered their own health.

Resumo O artigo discute pontos de vista, percepções, experiências, conhecimentos e comportamentos relacionados aos riscos ocupacionais entre os trabalhadores de reciclagem. Coleta de dados envolveu observação de campo e dois grupos focais em cada unidade. Narrativas foram gravadas, transcritas e analisadas por temas. Resultados são apresentados de acordo com os seguintes tópicos: valor econômico e ambiental da reciclagem; aspectos do sistema cooperativista; riscos ocupacionais e sugestões de melhorias. Programas municipais de coleta seletiva, tal como implantados na maioria dos municípios brasileiros, ainda precisam de melhorias para atingir suas metas e objetivos. Aprendemos que a organização de trabalhadores da reciclagem em cooperativas, apesar de sua ampla aceitação como um substituto para a coleta de lixo informal nas ruas e aterros, trouxe pouco progresso em relação à segurança e qualidade de vida dos cooperados. Os trabalhadores notaram a existência de riscos no local de trabalho, mas parecem resignados com a situação, consideram como parte do trabalho e não comunicam as suas necessidades aos supervisores. Eles ignoraram a existência de algumas medidas para evitar riscos e, por vezes, até criam práticas de trabalho e alternativas que colocam em perigo a própria saúde.

Evaluación de la gestión de residuos peligrosos (respel) y sus implicaciones en el desarrollo sostenible de las actividades productivas en cinco municipios del departamento del quindío, colombia / Assessment of hazardous waste management (respel) and its implications for sustainable development of productive activities in five municipalities of the department of quindio, colombia

Objetivos: Revisar la normatividad de residuos peligrosos en Colombia, su aplicabilidad y reglamentación, en un departamento pequeño que tiene una reducida generación, con el fin de identificar los vacíos existentes y la aplicabilidad de la política ambiental nacional, así como un análisis DOFA en la aplicabilidad de la normatividad de residuos peligrosos en el departamento del Quindío, comprobando la gestión integral y sus implicaciones. Metodología: La revisión incluyó la revisión de la comprensión de la normatividad, así como la bibliografía usada en la formulación de la política, los casos exitosos en otros países y la realización de encuestas en el trabajo de campo a los generadores de residuos, con lo cual se obtuvo la información necesaria para evaluar la aplicación de la Política Nacional en el departamento del Quindío. Resultados: Se visibilizaron las realidades de los generadores de residuos peligrosos en los cinco municipios del Quindío frente a la normativa ambiental y la Política Nacional, se encontró que la normativa nacional excluye a este sector, toda vez que hace exigencias que son difíciles de cumplir, por tanto no se aplica la norma. Discusión: Actualmente, no se promueve a nivel regional y nacional, la gestión de residuos peligrosos ni las opciones que faciliten el cumplimiento de las normas específicas, sin poner en riesgo la sustentabilidad ambiental, la sostenibilidad económica y social de los generadores de residuos peligrosos en los cinco municipios del Quindío. Conclusiones: Como producto de la investigación, se propone un modelo de gestión de residuos peligrosos, con dos variables dependiendo del volumen y características de los residuos generados, que incluye el ajuste normativo, la asociatividad de los generadores, una modificación del marco tarifario (con base en la regulación de los parámetros críticos de recolección y transporte), y el acompañamiento de los sectores comprometidos con la sostenibilidad ambiental, principalmente con la capacitación, formación ambiental y fortalecimiento técnico referido al manejo de los residuos o desechos peligrosos (líquidos, gaseosos, sólidos), orgánicos (que pueden tener procesos de compostaje) e inorgánicos (que pueden ser utilizados como reciclado o reutilizados como logística reversa o inversa) y los inservibles. Existe un gran desafío para un país, en especial cuando éste se enmarca en compromisos de convenios internacionales, al no tener en cuenta la heterogeneidad de las regiones, en cuanto a las capacidades de gestión y eliminación adecuada de residuos.

Objectives: To review the regulations for hazardous waste in Colombia, its applicability and regulation, in a small Department that has a reduced generation in order to identify gaps, and the applicability of the national environmental policy, as well as a DAFO analysis in the applicability of the regulations of hazardous waste in the department of Quindío, checking integrated management and its implications. Methodology: The revision included a review of the understanding of the regulations, as well as the literature used in the formulation of the policy, the successful cases in other countries and surveys to waste generators in the field work, with the purpose of obtaining the information needed to evaluate the implementation of the National Policy in the Department of Quindío. Results: The realities of hazardous waste generators became visible in the five municipalities of Quindío against the environmental regulations and the National Policy. It was found that the national legislation excludes this sector since it makes demands that are difficult to fulfill, therefore the rule is not applied. Discussion: Currently, management of hazardous waste or options to facilitate the achievement of specific standards without compromising environmental, economic and social sustainability of the generators of hazardous waste in the five municipalities of Quindío is not promoted at the regional and national level. Conclusions: As a result of the research, a model of hazardous waste management is proposed with two variables depending on the volume and characteristics of waste generated including regulatory setting, the association of the generators, a modification of the rate structure (based on the regulation of critical collection and transport parameters), and the accompaniment of the sectors committed to environmental sustainability, mainly through training, environmental education and technical strengthening relative to the handling of residues or hazardous waste (liquid, gaseous, solids), organic (which may have composting processes) and inorganic (which can be used as recycled or reused as reverse or inverse logistics) and unusable. There is a great challenge for a country, especially when it is part of commitments to international conventions, when it does not take into account the heterogeneity of the regions in terms of management skills and proper waste disposal.

Gestión ambiental en hospitales públicos: aspectos del manejo ambiental en Colombia / Environmental management in public hospitals: Environmental management in Colombia

Resumen Introducción. La actividad de los hospitales genera impactos ambientales que sin un manejo adecuado originan riesgos para la salud humana y ambiental; por esta razón, es necesaria una gestión ambiental hospitalaria que no solo se enfoque en el manejo de los residuos sólidos, sino que incluya todos los aspectos ambientales asociados a la actividad de las instituciones de salud. Objetivos. Revisar los aspectos de la gestión ambiental en los hospitales públicos para identificar alternativas de manejo ambiental y aspectos por mejorar. Materiales y métodos. Estudio cualitativo de corte descriptivo, con diseño transversal, que identifica algunas de las características más relevantes de la gestión ambiental en hospitales. Resultados. Se identificó que el enfoque generalizado de la gestión ambiental en los hospitales corresponde al manejo de los residuos sólidos hospitalarios y se descuidan otros aspectos que producen un impacto ambiental negativo en el ambiente próximo como consumo de energía, consumo de agua, manejo de alimentos y manejo de medicamentos, entre otros. Conclusiones. Los hospitales pueden aplicar instrumentos de gestión ambiental más amplios que incluyan análisis de ciclo de vida de sus servicios y productos, seguimiento a la huella de carbono y que tengan en cuenta las diferentes áreas de impacto ambiental de su operación.

Abstract Introduction: Activities in hospitals have environmental impacts which may pose risks to human and environmental health if they are not managed correctly. For this reason, it is necessary to implement an environmental management plan in hospitals that not only focuses on solid waste management but includes all aspects associated with health within institutions. Objective: To review environmental management aspects related to public hospitals in order to identify environmental management alternatives and aspects to improve. Materials and methods: Descriptive qualitative study with cross-sectional design, which identifies some of the most important characteristics of environmental management in hospitals. Results: The general approach to environmental management in hospitals is related to the management of solid waste, and other aspects that have a negative environmental impact on the surrounding areas, such as energy and water consumption, food handling and medication waste, among others, are not properly addressed. Conclusions: Hospitals can apply broader environmental management instruments, including life cycle analysis of their products and services and monitoring of the carbon footprint; they may also take into account the different areas of environmental impact of their operation.

LÓGICA DE LA GESTIÓN AMBIENTALMENTE ADECUADA Y PATRÓN DE DESARROLLO SUSTENTABLE EN AMÉRICA LATINA: EL TEMA EMBLEMÁTICO DE LAS POLÍTICAS DE RESIDUOS PELIGROSOS EN ARGENTINA EN LOS AÑOS 90 / LOGICS OF ENVIRONMENTALLY ADEQUATE MANAGEMENT AND THE SUSTAINABLE DEVELOPMENT PATTERN: THE EMBLEMATIC ISSUE OF THE HAZARDOUS WASTE POLICIES IN ARGENTINA IN THE 90' s

Este trabajo presenta un análisis político-discursivo del proceso de ecologización experimentado por los mercados y Estados latinoamericanos durante la década de los 90 a través del estudio del tema emblemático de las políticas de gestión ambientalmente adecuada de residuos peligrosos en Argentina. La perspectiva en la que se inscribe este artículo es la del análisis posmarxista de políticas que busca poner énfasis en los momentos fundacionales de los procesos de significación implicados en las políticas públicas. Para la comprensión y crítica de tal proceso de ecologización, se identificó a la lógica de la gestión ambientalmente adecuada como categoría que permitió condensar un cúmulo de prácticas discursivas orientadas a: reducir al Estado a mero gestor del mercado, autorrestringir sus atribuciones soberanas y limitar su tarea en torno a los residuos peligrosos a la función registral en pos de favorecer a las estrategias de autocontrol empresarial. La explicación del problema de investigación construida a partir de la lógica de la gestión ambientalmente adecuada dio lugar, a su vez, a la identificación de una hipótesis explicativa central del proceso de ecologización de los años 90 en Argentina y América Latina: al desarrollo sustentable en tanto patrón de desarrollo y referencia de sentido central en la década a la hora de significar a los problemas ambientales y sus soluciones más adecuadas. La idea de patrón implica, en este caso, antes que cualquier pretendida intervención humanitaria-ecológica internacional para la protección técnica del entorno natural, la vía más adecuada para, por un lado, la radicalización de las condiciones estructuralmente heterogéneas de una economía periférica como la Argentina y, por otro, la profundización de las asimetrías entre los países del Norte y los del Sur así como también la transnacionalización del aparato productivo nacional.

This article presents a discursive-political analysis of the greening process experienced by the markets and Latin American States during the 90's through the study of the emblematic issue of the environmentally sound management policies of hazardous waste in Argentina. The perspective of this article is the post-Marxist analysis of policies that seeks to put emphasis on the founding moments of significant processes involved in public policies. To understand and critique such greening process, it was necessary to identify the logic of the adequate environmentally sound management as a category that allowed condensing a cluster of discursive practices aimed at: reducing the State to mere market operator, self-restrict its sovereign powers, and limit its work around hazardous waste to the information recording function towards favoring strategies of business self-control. The explanation of the research problem constructed from the logic of the environmentally sound management led, in turn, to the identification of a central explanatory hypothesis of the greening process in the 90's in Argentina and Latin America: sustainable development as development pattern and central reference point in the decade when it comes to signify environmental problems and their most adequate solutions. The idea of pattern implies in this case, rather than any supposed international humanitarian-ecological intervention for the technical protection of the natural environment, the most adequate, on one hand, for the radicalization of structurally heterogeneous conditions of peripheral economy such as the Argentinian economy and, on the other hand, to go deeper into the asymmetries between the North and South countries as well as the transnationalism of the national productive.

Solid waste management in primary healthcare centers: application of a facilitation tool / Gerenciamento de resíduos sólidos em unidades básicas de saúde: aplicação de instrumento facilitador / Gestión de residuos sólidos en las unidades básicas de salud: aplicación de instrumento facilitador

Abstract Objectives: to propose a tool to facilitate diagnosis, formulation and evaluation of the Waste Management Plan in Primary Healthcare Centers and to present the results of the application in four selected units. Method: descriptive research, covering the stages of formulation /application of the proposed instrument and the evaluation of waste management performance at the units. Results: the tool consists in five forms; specific indicators of waste generation for outpatients healthcare units were proposed, and performance indicators that give scores for compliance with current legislation. In the studied units it is generated common waste (52-60%), infectious-sharps (31-42%) and recyclable (5-17%). The average rates of generation are: 0,09kg of total waste/outpatient assistance and 0,09kg of infectious-sharps waste/outpatient procedure. The compliance with regulations, initially 26-30%, then reached 30-38% a year later. Conclusion: the tool showed to be easy to use, bypassing the existence of a complex range of existing regulatory requirements, allowed to identify non-conformities, pointed out corrective measures and evaluated the performance of waste management. In this sense, it contributes to decision making and management practices relating to waste, tasks usually assigned to nurses. It is recommended that the tool be applied in similar healthcare units for comparative studies, and implementation of necessary adaptations for other medical services.

Resumo Objetivos: propor instrumento para facilitar diagnóstico, elaboração e avaliação de Plano de Gerenciamento de Resíduos em Unidades Básicas de Saúde e apresentar os resultados da aplicação em quatro unidades selecionadas. Método: pesquisa descritiva que contemplou as etapas de construção/aplicação do instrumento proposto e a avaliação de desempenho do gerenciamento de resíduos nas unidades estudadas. Resultados: geração de instrumento composto por cinco formulários; proposta de indicadores específicos de geração de resíduos para unidades assistenciais de saúde sem internação e indicador de desempenho que pontua o atendimento à legislação vigente. Nas unidades estudadas, são gerados resíduos comuns (52-60%), infectantes/perfurocortantes (31-42%) e recicláveis (5-17%). As taxas médias de geração são: 0,09kg de resíduos totais/atendimento e 0,09kg de resíduos infectantes-perfurocortantes/procedimento. O atendimento à normativa, inicialmente de 26-30%, atingiu 30-38% um ano depois. Conclusão: o instrumento mostrou-se de fácil aplicação, contornando a existência de complexa gama de requisitos regulatórios vigentes, possibilitou identificar não conformidades, apontar medidas corretivas e avaliar o desempenho da gestão de resíduos. Nesse sentido, contribui para tomada de decisão e práticas gerenciais referentes aos resíduos, tarefas geralmente atribuídas a enfermeiros. Recomenda-se a aplicação do instrumento em unidades de saúde similares para estudos comparativos, e as adaptações necessárias para outros serviços de saúde.

Resumen Objetivos: proponer un instrumento para facilitar el diagnóstico, elaboración y evaluación del plan de gestión de residuos en unidades básicas de salud y presentar la aplicación de los resultados en cuatro unidades seleccionadas. Método: investigación descriptiva, cubriendo las etapas de la formulación/aplicación del instrumento propuesto y la evaluación de desempeño de la gestión de residuos en las unidades estudiadas. Resultados: el instrumento está compuesto por cinco formularios; propuesta de indicadores específicos de la generación de residuos para las unidades de atención de salud sin hospitalización e indicador de desempeño que puntúa el cumplimiento de la legislación vigente. Los residuos que generan las unidades estudiadas son de tipo común (52-60%), infecciosos/punzocortantes (31-42%) y reciclables (5-17%). Las tasas promedio de generación son: total de residuos/atendimiento 0,09kg y 0,09kg de residuos infecciosos-punzocortantes/procedimiento. El cumplimiento de la normativa, inicialmente 26-30%, alcanzó 30-38% un año más tarde. Conclusión: el instrumento se mostró fácil de usar, evita pasar por una gama compleja de disposiciones normativas existentes, permitió identificar posibles casos de incumplimiento, señalar medidas correctivas puntuales y evaluar el desempeño de la gestión de residuos. En este sentido, contribuye a la toma de decisiones y a prácticas de gestión relativas a los residuos, tareas normalmente asignadas a los enfermeros. Se recomienda la aplicación del instrumento en unidades de salud similares para estudios comparativos, y las adaptaciones necesarias para otros servicios de salud.

Normativas para la gestión de residuos biopatogénicos en Argentina / Regulations on bio-pathogenic waste management in Argentina

INTRODUCCIÓN: la gestión de los residuos de establecimientos de atención de la salud plantea variados problemas técnicos y es influida por las circunstancias culturales, sociales yeconómicas. En Argentina, la operación está inmersa en un complejo escenario legal donde coexisten 18 marcos legislativos diferentes para residuos biopatogénicos. OBJETIVOS: Proveer las herramientas para la construcción colectiva y federal de presupuestos mínimos en la materia. MÉTODOS: Se realizó una revisión comparativa de las leyes provinciales y sus decretos reglamentarios, cotejándolas con la ley nacional para cada aspecto y siguiendo las sucesivas etapas de la gestión interna de los residuos generados en establecimientos de atención de la salud. RESULTADOS: Se relevaron 67 normas: 5 nacionales, 40 leyes provinciales y 22 decretos provinciales. En la mayoría de los ítems comparados se observó una gran diversidad de criterios y diferente nivel de profundización. CONCLUSIONES: Argentina necesita poner en agenda la actualización de las normativas de residuos de establecimientos de atención de la salud con un enfoque inclusivo de la salud ambiental y laboral, para construir presupuestos mínimos en la temática de manera colectiva y federal.

INTRODUCTION: health care waste management poses various technical problems and is influenced by cultural,social and economic contexts. In Argentina, this takes place in a complex legal scenario with the coexistence of 18 different legalframeworks for bio-pathogenic waste. OBJECTIVES: To provide the tools for the collective federal construction of mínimum agreements in this field. METHODS: A comparative review wasperformed on provincial laws and their regulatory decrees. It involved a comparison with the national law for every aspect, following the successive stages of internal health care wastemanagement. RESULTS: The review included 67 legal dispositions: 5 at national level, 40 provincial laws and 22 provincial decrees. Most of the items showed a great diversity of criteria and different depth level. CONCLUSIONS: Argentina needs toupdate the regulations on health care waste management with an inclusive approach to environmental and occupational health, in order to develop the collective federal construction of minimum agreements.

El trabajador de la salud y el riesgo de enfermedades infecciosas adquiridas. Las precauciones estándar y de bioseguridad / Healthcare providers and the risk of acquired infectious diseases. Standard and biosafety precautions

Resumen El trabajador de la salud (médicos, enfermeras, paramédicos, laboratoristas clínicos, etc.), por su actividad diaria está en riesgo de adquirir accidentalmente una enfermedad infecciosa. El contacto con pacientes, fluidos biológicos y el cultivo o aislamiento de microorganismos infecciosos durante el trabajo de laboratorio son factores que aumentan ese riesgo, y para disminuirlo se requiere de la aplicación de medidas preventivas o precauciones estándar de bioseguridad para cada una de sus actividades, por lo tanto, debe contar con el entrenamiento necesario. El uso de guantes, cubrebocas, mascarillas, bata, así como la disposición adecuada de los residuos peligrosos biológico-infecciosos (RPBI) resultan primordiales en el trabajo diario. Aunado esto, el lavado de manos, el cambio frecuente de la bata u otra vestimenta hospitalaria son de gran importancia para evitar las infecciones nosocomiales. Es importante considerar, que la carga de trabajo y el estrés ocupacional son factores adicionales que aumentan las probabilidades de incurrir en errores o accidentes laborales que provoquen infecciones en el personal de salud. Nuestro objetivo es presentar los factores de riesgo a los que se expone el trabajador de la salud durante sus actividades diarias y contribuir a la difusión y divulgación de la correcta aplicación de las precauciones universales de bioseguridad para disminuir el riesgo de adquirir una enfermedad infecciosa.

Abstract Healthcare providers (doctors, nurses, paramedics, laboratory technicians, surgeons, etc.) are at risk of accidentally acquiring an infectious disease as a consequence of their everyday activities. Preventive measures or standard biosafety precautions for each one of the activities to perform are required; therefore, health providers must know and have the appropriate training to prevent these infections. For instance, the use of gloves, surgical masks, masks, laboratory coat, as well as the correct disposal of trained to Contact with patients, biological fluids and the culture or isolation of infectious microorganisms during laboratory work are factors increasing that risk. To reduce the risk of acquiring an infectious disease, it requires the application of preventive measures or appropriate biosecurity standard precautions for each of the activities to be performed, so the health worker must know and have the necessary training to prevent these infections in this sense the use of gloves, masks, gown, and the correct management of the Biological-infectious Hazardous Waste (BIHW) are of primary importance in daily work. In addition, hand-washing, frequent change of the coat or any other hospital clothes is very important to prevent hospital-acquired infections. Finally, it is important to consider that the workload and occupational stress are additional factors that increase the chances of work mistakes or accidents causing healthcare personnel acquire infections. The aim of this paper is to present a profile of risk factors to which the health worker is exposed during his/her daily activities and contribute to the dissemination and disclosure of the correct application of the universal biosafety precautions in order to decrease the risk of acquiring an infectious disease.

Estudio comparativo de las normas relevantes a nivel internacional para la definición, clasificación, exclusión, desclasificación e identificación de residuos peligrosos / Comparative study of the international significant standards for the definition, exclusion, declassification and identification of hazardous wastes

El presente artículo realiza una comparación de las normas relevantes a nivel internacional para la definición, clasificación, exclusión, desclasificación e identificación de residuos peligrosos. Dentro de los principales sistemas de clasificación de residuos peligrosos se encuentran: La Convención de Basilea sobre el control de los movimientos transfronterizos de los desechos peligrosos y su eliminación, El Listado Europeo de Residuos (LER) y el Código de Regulación Federal de los Estados Unidos 40 CFR 261. Las tres normas, presentan grandes diferencias en relación a los criterios de clasificación e identificación de un residuo peligroso y, por tanto, frente a sus propios listados de clasificación. Por esta razón, el presente trabajo pretende realizar un análisis crítico comparativo entre las tres regulaciones con el objeto de analizar las ventajas e inconvenientes en relación a la definición, identificación, clasificación, exclusión y desclasificación de residuos peligrosos.

In this article the international important standards of hazardous wastes are compared including definition, exclusion, declassification and identification. Some of the main hazardous wastes classification systems are: Basel convention about the control of cross-border movement of hazardous waste and its elimination, the European list of wastes (LER) and the U.S code of federal regulations 40 CFR 261. The three standards have big differences regarding the classification criteria and identification of hazardous waste therefore about their own classification lists. For this reason, this article aims to make a critical and comparative analysis between the three regulations to analyze the advantages and disadvantages in regard to different aspects related to this problematic (definition, exclusion, declassification and identification of hazardous wastes).

Mercury Exposure among Garbage Workers in Southern Thailand

OBJECTIVES: 1) To determine mercury levels in urine samples from garbage workers in Southern Thailand, and 2) to describe the association between work characteristics, work positions, behavioral factors, and acute symptoms; and levels of mercury in urine samples. METHODS: A case-control study was conducted by interviewing 60 workers in 5 hazardous-waste-management factories, and 60 matched non-exposed persons living in the same area of Southern Thailand. Urine samples were collected to determine mercury levels by cold-vapor atomic absorption spectrometer mercury analyzer. RESULTS: The hazardous-waste workers' urinary mercury levels (10.07 microg/g creatinine) were significantly higher than the control group (1.33 microg/g creatinine) (p < 0.001). Work position, duration of work, personal protective equipment (PPE), and personal hygiene, were significantly associated with urinary mercury level (p < 0.001). The workers developed acute symptoms - of headaches, nausea, chest tightness, fatigue, and loss of consciousness at least once a week - and those who developed symptoms had significantly higher urinary mercury levels than those who did not, at p < 0.05. A multiple regression model was constructed. Significant predictors of urinary mercury levels included hours worked per day, days worked per week, duration of work (years), work position, use of PPE (mask, trousers, and gloves), and personal hygiene behavior (ate snacks or drank water at work, washed hands before lunch, and washed hands after work). CONCLUSION: Changing garbage workers' hygiene habits can reduce urinary mercury levels. Personal hygiene is important, and should be stressed in education programs. Employers should institute engineering controls to reduce urinary mercury levels among garbage workers.

Mercury Exposure among Garbage Workers in Southern Thailand

OBJECTIVES: 1) To determine mercury levels in urine samples from garbage workers in Southern Thailand, and 2) to describe the association between work characteristics, work positions, behavioral factors, and acute symptoms; and levels of mercury in urine samples. METHODS: A case-control study was conducted by interviewing 60 workers in 5 hazardous-waste-management factories, and 60 matched non-exposed persons living in the same area of Southern Thailand. Urine samples were collected to determine mercury levels by cold-vapor atomic absorption spectrometer mercury analyzer. RESULTS: The hazardous-waste workers' urinary mercury levels (10.07 microg/g creatinine) were significantly higher than the control group (1.33 microg/g creatinine) (p < 0.001). Work position, duration of work, personal protective equipment (PPE), and personal hygiene, were significantly associated with urinary mercury level (p < 0.001). The workers developed acute symptoms - of headaches, nausea, chest tightness, fatigue, and loss of consciousness at least once a week - and those who developed symptoms had significantly higher urinary mercury levels than those who did not, at p < 0.05. A multiple regression model was constructed. Significant predictors of urinary mercury levels included hours worked per day, days worked per week, duration of work (years), work position, use of PPE (mask, trousers, and gloves), and personal hygiene behavior (ate snacks or drank water at work, washed hands before lunch, and washed hands after work). CONCLUSION: Changing garbage workers' hygiene habits can reduce urinary mercury levels. Personal hygiene is important, and should be stressed in education programs. Employers should institute engineering controls to reduce urinary mercury levels among garbage workers.

Dental perspective on biomedical waste and mercury management: A knowledge, attitude, and practice survey.

Context: Management of waste generated in any health-care facility is a critical issue as it poses a direct threat to human health as well as to the environment. The biomedical waste generated in the dental scenario includes sharps, used disposable items, infectious waste (blood-soaked cotton, gauze, etc.), hazardous waste (mercury, lead), and chemical waste (such as spent film developers, fixers, and disinfectants). A major concern in our field is management and disposal of mercury. Aims: To obtain information about the knowledge, attitude, and practices of dental institutions and dental practitioners in the disposal of waste. Settings and design: A self-administered questionnaire, composed of 50 questions was designed. Materials and Methods: The questionnaire was distributed among the participants, chosen randomly, including dental students, faculty from dental colleges and private practitioners in and around Delhi, India. Statistical analysis used: The percentage response for each question from all the participants was obtained and the data was calculated. Results: Many dentists have knowledge about the waste management but they lack in the attitude and practice. Conclusions: There is need for education regarding hazards associated with improper waste disposal at all levels of dental personnel. It is imperative that waste should be segregated and disposed off in a safe manner to protect the environment as well as human health.

A coincineração de resíduos em fornos de cimento: riscos para a saúde e o meio ambiente / Co-incineration in cement kilns: health and environmental risks

O objetivo do artigo é discutir a forma como a coincineração de resíduos em fábricas de cimento vem crescendo no Brasil, bem como seus impactos sobre a saúde humana e o meio ambiente. Informações gerais sobre mercado e efeitos sobre a saúde foram obtidas através de revisão bibliográfica e alguns estudos de caso, escolhidos a partir de debate com integrantes da Rede Brasileira de Justiça Ambiental, foram construídos para ilustrar a situação no Brasil. Os estudos encontrados mostraram que, independente do nível de desenvolvimento tecnológico dos países, a saúde dos trabalhadores e das pessoas que moram próximas às fábricas de cimento vem sendo prejudicada pela poluição emitida pelas empresas de cimento, em especial por aquelas que praticam a coincineração. Além disso, no contexto brasileiro, a vulnerabilidade das instituições e populações afetadas tende a agravar este problema. Como conclusão, defende-se o aumento da capacidade institucional dos órgãos brasileiros responsáveis pelo monitoramento das atividades industriais, bem como uma rediscussão mais aprofundada dos aspectos políticos e éticos ligados ao transporte e comércio de resíduos industriais.

In this article we discuss the development of hazardous waste co-incineration in cement kilns in Brazil as well as its impacts on health and the environment. Information was gathered through an extensive review on social and environmental impacts of co-incineration, and case studies, chosen after discussion with social movement representatives concerned with the co-incineration issue and related to the Brazilian Network on Environmental Justice, are described to illustrate the reality of co-incineration in Brazil. Studies showed that workers and community health suffers negative impacts from such practices in high-, middle- and low-income countries. In the Brazilian context, the institutional and social vulnerability intensifies these problems. To conclude, we argue for the necessity of increasing the institutional capacity of health and environmental agencies in Brazil, through staff training and better infra-structure. Additionally, we also propose a return of the debate about political and ethical aspects of industrial waste trade.

Residuos hospitalarios peligrosos en un centro de alta complejidad / Management of hazardous waste in a hospital

Background: An inadequate management of hospital waste, that have toxic, infectious and chemical wastes, is a risk factor for humans and environment. Aim To identify, quantify and assess the risk associated to the management of hospital residues. Material and methods: A cross sectional assessment of the generation of hazardous waste from a hospital, between June and August 2005, was performed. The environmental risk associated to the management of non-radioactive hospital waste was assessed and the main problems related to solid waste were identified. Results: The rate of generation of hazardous non-radioactive waste was 1.35 tons per months or 0.7 kg/bed/day. Twenty five percent of hazardous liquid waste were drained directly to the sewage system. The drug preparation unit of the pharmacy had the higher environmental risk associated to the generation of hazardous waste. The internal transport of hazardous waste had a high risk due to the lack of trip planning. The lack of training of personnel dealing with these waste was another risk factor. Conclusions: Considering that an adequate management of hospital waste should minimize risks for patients, the hospital that was evaluated lacks an integral management system for its waste.

Los residuos peligrosos en México. Evaluación del riesgo para la salud / Hazardous waste in Mexico. health risk assessment

En México más del 90 por ciento de los residuos peligrosos que se producen al año se manejan inadecuadamente. Por conseguir, el grueso de los residuos se dispone de manera anómala en el ambiente, contaminando ríos, cañadas, desiertos, etcétera. En el presente trabajo se mencionan los efectos sobre la salud ocasionados por dichos contaminantes, las alternativas tecnológicas para enfrentar ese problema y se hacen propuestas para un programa que trate de manera simultánea el control de los residuos que se están produciendo y el estudio de los sitios que ya han sido contaminados. Este programa debe considerar las limitaciones de los países en desarrollo, entre otras: falta de laboratorios, escasez de recursos humanos y apoyos económicos restringidos. Además, se señala, deberá completar la desnutrición de la población y las enfermedades microbiológicas que aún son un impotante factor de morbilidad en muchas zonas del país. Aunado a lo anterior, es fundamental una mayor participación de la Secretaría de Salud en los temas relacionados con los residuos peligrosos

In Mexico about 90% of the hazardous waste is not treated adequately. Thus, a sizable proportion of the waste is improperly disposed of and released into the environment, polluting rivers, deserts, etcetera. The present article describes the health effects of hazardous waste and the technological alternatives to tackle these problems. In order to assess the risks posed by hazardous waste sites, a new approach, adapted to the health conditions and scarce resources of the country, has to be developed. The health conditions include malnutrition and infectious diseases; the scarcity of resources refers to qualified environmental laboratories, human resources with expertise in environmental sciences, and funding for the evaluation of hazardous waste sites. Furthermore, a more direct participation of the Ministry of Health in issues related to hazardous waste is needed. These elements should be taken into account to create a National Program for the Study of Hazardous Waste in Mexico.