ABSTRACT
The effect of the COVID-19 pandemic on medical waste EWC/EURAL code 180103* (infectious medical waste) and 180104 (non-infectious medical waste) was investigated in 6 university hospitals and 6 general hospitals. Data on the number of in-hospital patients and on quantity and volume of waste were obtained during 2019 (control period) and in 2020 up to March 2021 (COVID-19 period) for the hospitals, from the waste managing company, and from the regional destruction facility. The presence of SARS-CoV-2 on the surface of waste recipients was analyzed using RTPCR. We found that the effect of the pandemic on the total weight of waste is limited during the first wave (March 2020), while during the second wave, the quantity of waste type 180103* increased. The main effect is a nearly doubling of the volume of waste during both waves caused by the use of cardboard hospital boxes with a yellow inner plastic bag. We demonstrated that the average weight of these cardboard boxes generated for the treatment of COVID-19 patients is significantly lower compared to the weight of the waste from non-COVID-19 patients. COVID-19-related health care activities caused a weight increase of the 180103* waste from historical data (0.2-1.4 kg/day/bed) up to 5-8 kg/day/bed. RT-PCR analysis of swabs demonstrated the absence of viral RNA on personal protection materials and on the surface of recipients containing the waste. We conclude that COVID-19-related hospital waste is predominantly of the EWC 180104 type.
ABSTRACT
INTRODUCTION: We present the results of the COVID-19 rule-out protocol at Ghent University Hospital, a step-wise testing approach which included repeat NFS SARS-CoV-2 rRT-PCR, respiratory multiplex RT-PCR, low-dose chest CT and bronchoscopy with BAL to confirm or rule-out SARS-CoV-2 infection in patients admitted with symptoms suggestive of COVID-19. RESULTS: Between 19 March 2020 and 30 April 2020, 455 non-critically ill patients with symptoms suspect for COVID-19 were admitted. The initial NFS for SARS-CoV-2 rRT-PCR yielded 66.9%, the second NFS 25.4% and bronchoscopy with BAL 5.9% of total COVID-19 diagnoses. In the BAL fluid, other respiratory pathogens were detected in 65% (13/20) of the COVID-19 negative patients and only in 1/7 COVID-19 positive patients. Retrospective antibody testing at the time around BAL sampling showed a positive IgA or IgG in 42.9 % of the COVID-19 positive and 10.5% of the COVID-19 negative group. Follow-up serology showed 100% COVID-19 positivity in the COVID-19 positive group and 100% IgG negativity in the COVID-19 negative group. CONCLUSION: In our experience, bronchoscopy with BAL can have an added value to rule-in or rule-out COVID-19 in patients with clinical and radiographical high-likelihood of COVID-19 and repeated negative NFS testing. Furthermore, culture and respiratory multiplex PCR on BAL fluid can aid to identify alternative microbial etiological agents in this group. Retrospective analysis of antibody development in this selected group of patients suggests that the implementation of serological assays in the routine testing protocol will decrease the need for invasive procedures like bronchoscopy.