Benefits and costs of alternative healthcare waste management: an example of the largest hospital of Nepal.

Background: Management of health-care waste is an essential task, which has important consequences for public health and the well-being of society. Economic evaluation is important for strategic planning and investment programming for health-care waste management (HWM). A cost–benefit analysis of an alternative method of HWM in Bir hospital, Nepal was carried out using data recently collected from primary sources. Methods: Data were collected using mixed quantitative and qualitative methods. Costs and benefits were measured in Nepalese rupees. The values of all inputs were costs associated with the alternative HWM. Benefits were defined as the reduction in cost of transportation; money obtained from selling of recycled waste; and risk reduction, among others. Break-even analysis and calculations of benefit– cost ratio were used to assess the alternative HWM. Results: The alternative HWM reduces the cost of waste disposal by almost 33% per month, owing to reduction in the amount of waste for disposal. The hospital earns 3 Nepalese rupees per bed per day. The results suggest that a break-even point for costs and benefits occurs when 40% of the total beds of the hospital are covered by the alternative HWM, if the bed occupancy rate is at least 68%. If the alternative HWM is introduced in the hospital system, hospitals can reach the break-even point at 40 to 152 beds, depending on their performance in HWM. Conclusions: The results show the economic feasibility and financial sustainability of the alternative HWM. This alternative method of HWM is a successful candidate for replication in all public and private hospitals in Nepal.

Eficacia da descontaminacao de residuos biologicos infectantes de laboratorios de microbiologia apos tratamento termico por autoclavacao / Efficacy of the decontamination of biological infectious waste after thermal treatment by autoclaving

A pesquisa foi realizada no Laboratório Central de Saúde Pública de Minas Gerais com o objetivo de validar o processo de descontaminação de resíduos infectantes do subgrupo A1 e identificar possíveis falhas no procedimento preliminar à sua disposição final. Foram avaliados tanto a descontaminação dos resíduos totalmente descartáveis acondicionados em sacos plásticos termorresistentes quanto o processo de descontaminação dos resíduos reutilizáveis provenientes do Laboratório de Tuberculose, acondicionados em caixas metálicas. Enquanto os resultados obtidos no primeiro estudo indicaram uma deficiência considerável no tratamento dos resíduos, no segundo caso a eficácia foi comprovada. Medidas preventivas e corretivas foram propostas e adotadas como consequência deste trabalho, e são aqui descritas.

Laboratory studies were performed at the Central Laboratory of Public Health of Minas Gerais in order to validate the process of infectious waste decontamination (subgroup A1) from the public health service and identify possible flaws in the procedure preliminary to its final disposal. We evaluated both the decontamination of disposable waste packed in thermo-resistant plastic bags as well and the decontamination process of reusable waste from the Tuberculosis Laboratory packed in metallic boxes. The results of the first study indicated a significant deficiency in waste treatment, while in the second case efficacy was demonstrated. Preventive and corrective measures were proposed and adopted as a result of this work and are described herein.