Going green: decreasing medical waste in a paediatric intensive care unit in the United States.

The healthcare industry generates significant waste and carbon emissions that negatively impact the environment. Intensive care units (ICU) are a major contributor to the production of waste, due to patient complexity and needs requiring extensive equipment, cleaning practices and pre-emptive supplies. To quantify the extent of the problem, health care professionals collected all unused medical supplies destined to be discarded over three one-week periods in a paediatric intensive care unit, weighed the items, and created an inventory. This article argues for greener hospital standards and provides a specific example of a project framework to reduce disposable waste with the hope that others can embark on similar initiatives for a more ethical and sustainable future for hospitals. Healthcare facilities must not just meet short-sighted safety standards of the now. In order to be a virtuous organization, one must consider all implications of daily decisions, including disposable supplies and cleaning.

Healthcare waste management current status and potential challenges in Ethiopia: a systematic review.

OBJECTIVE: During the healthcare delivery process, hazardous wastes can be generated from the health facilities. Improper healthcare waste management is responsible for the transmission of more than 30 dangerous bloodborne pathogens. The aim of this systematic review was to evaluate the healthcare waste management practice and potential challenges in Ethiopia. RESULTS: Electronic databases and direct Google search yielded 1742 articles from which 17 studies met the inclusion criteria. The proportion of hazardous waste generated in Ethiopian healthcare facilities was unacceptably high which ranged from 21 to 70%. Most studies indicated the absence of proper waste segregation practice at the source of generation. Treatment of the healthcare waste using low combustion incinerator and/or open burning and open disposal of the incinerator ash were very common. Lack of awareness from the healthcare staff, appropriate waste management utilities and enforcement from the regulatory bodies were mainly identified as a common factor shared by most of the studies. The healthcare waste management practice in Ethiopian healthcare facilities was unsatisfactory. There should be close supervision of the waste disposal process by the regulatory bodies or other stakeholders.

Contextual factors and motivations affecting rural community sanitation in low- and middle-income countries: A systematic review.

BACKGROUND: Unsafe management of human faecal waste represents a major risk for public health, particularly in low- and middle-income countries. Efforts to improve sanitation conditions are considerably sensitive to contextual specifics of natural and social environments. This review operationalises, analyses, and synthesises evidence of how contextual factors and motivations affect different sanitation outcomes with a specific focus on community approaches to rural sanitation. METHODS AND FINDINGS: We operationalised contextual factors and motivations as determinants that influence sanitation conditions independently of the examined intervention. We conducted a systematic search of both peer-reviewed and grey literature with no restriction on the methods After screening the titles and abstracts of 19,198 records obtained through initial searches, we scrutinised the full content of 621 studies for relevance. While 102 of these studies qualified to be assessed for risk of bias and information content, ultimately, just 40 studies met our eligibility criteria. Of these 40 studies from 16 countries, 26 analysed specific interventions and 14 were non-interventional. None of the experimental studies reported the effects of contextual factors or motivations as operationalised in this study and only observational evidence was thus used in our review. We found that sanitation interventions are typically seen as the principal vehicles of change, the main instruments to fix 'deviant' behaviour or ensure access to infrastructure. The programmatic focus of this study on sanitation determinants that act independently of specific interventions questions this narrow understanding of sanitation dynamics. We identified 613 unique observations of quantitatively or qualitatively established relationships between certain contextual factors or motivations and 12 different types of sanitation outcomes. The sanitation determinants were classified into 77 typologically similar groups clustered into 12 broader types and descriptively characterised. We developed a graphical synthesis of evidence in the form of a network model referred to as the sanitation nexus. The sanitation nexus depicts how different groups of determinants interlink different sanitation outcomes. It provides an empirically derived conceptual model of sanitation with an aggregate structure indicating similarities and dissimilarities between sanitation outcomes with respect to how their sets of underlying determinants overlap. CONCLUSION: This study challenged the understanding of context as merely something that should be controlled for. Factors that affect targeted outcomes independently of the analysed interventions should be scrutinised and reported. This particularly applies to interventions involving complex human-environment interactions where generalisability is necessarily indirect. We presented a novel approach to comprehending the contextual factors and motivations which influence sanitation outcomes. Our approach can be analogously applied when mapping and organising underlying drivers in other areas of public and environmental health. The sanitation nexus derived in this study is designed to inform practitioners and researchers about sanitation determinants and the outcomes they influence.

A preliminary approach to quantifying the overall environmental risks posed by development projects during environmental impact assessment.

Environmental impact assessment (EIA) is used globally to manage the impacts of development projects on the environment, so there is an imperative to demonstrate that it can effectively identify risky projects. However, despite the widespread use of quantitative predictive risk models in areas such as toxicology, ecosystem modelling and water quality, the use of predictive risk tools to assess the overall expected environmental impacts of major construction and development proposals is comparatively rare. A risk-based approach has many potential advantages, including improved prediction and attribution of cause and effect; sensitivity analysis; continual learning; and optimal resource allocation. In this paper we investigate the feasibility of using a Bayesian belief network (BBN) to quantify the likelihood and consequence of non-compliance of new projects based on the occurrence probabilities of a set of expert-defined features. The BBN incorporates expert knowledge and continually improves its predictions based on new data as it is collected. We use simulation to explore the trade-off between the number of data points and the prediction accuracy of the BBN, and find that the BBN could predict risk with 90% accuracy using approximately 1000 data points. Although a further pilot test with real project data is required, our results suggest that a BBN is a promising method to monitor overall risks posed by development within an existing EIA process given a modest investment in data collection.

Recycling and social technologies for sustainability: The Brazilian experience of wastepickers' inclusion in selective collection programs.

BACKGROUND: Alternatives are being developed for waste treatment all over the world. Solidary selective collection is a recognized social technology for taking millions of people out of absolute poverty. However, this technology raises crucial questions regarding its nature and development perspective. What can be said of the legitimacy of a social technology that is born from misery and maintains wastepickers in precarious work conditions? OBJECTIVE: This article approaches issues based on the analysis of the wastepickers' work process, highlighting the difficulties and interpersonal conflicts, the strong social bonds and creativity that reveal the potential of efficiency and solidarity of this social technology. METHODS: The analyses are founded on empirical descriptions of work situations and organizational arrangements that the wastepickers themselves have developed. The observations were made during the work, followed by interviews focused on significant events and behaviors. RESULTS: The contradiction between efficiency and solidarity, which excludes workers from the formal labor market, finds in the associations a solution for people with different capacities. This social technology offers much more than simple survival or exoticism. The wastepickers create a sustainable mode of production, putting together economic, social and environmental criteria in an innovative and fair production technology.

A 'Knowledge Ecologies' Analysis of Co-designing Water and Sanitation Services in Alaska.

Willingness to collaborate across disciplinary boundaries is necessary but not sufficient for project success. This is a case study of a transdisciplinary project whose success was constrained by contextual factors that ultimately favoured technical and scientific forms of knowledge over the cultural intelligence that might ensure technical solutions were socially feasible. In response to Alaskan Water and Sewer Challenge (AWSC), an international team with expertise in engineering, consultative design and public health formed in 2013 to collaborate on a two-year project to design remote area water and sanitation systems in consultation with two native Alaskan communities. Team members were later interviewed about their experiences. Project processes are discussed using a 'Knowledge Ecology' framework, which applies principles of ecosystems analysis to knowledge ecologies, identifying the knowledge equivalents of 'biotic' and 'abiotic' factors and looking at their various interactions. In a positivist 'knowledge integration' perspective, different knowledges are like Lego blocks that combine with other 'data sets' to create a unified structure. The knowledge ecology framework highlights how interactions between different knowledges and knowledge practitioners ('biotic factors') are shaped by contextual ('abiotic') factors: the conditions of knowledge production, the research policy and funding climate, the distribution of research resources, and differential access to enabling infrastructures (networks, facilities). This case study highlights the importance of efforts to negotiate between different knowledge frameworks, including by strategic use of language and precepts that help translate social research into technical design outcomes that are grounded in social reality.

Investigating motivating factors for sound hospital waste management.

UNLABELLED: Sustainable management of hospital waste requires an active involvement of all key players. This study aims to test the hypothesis that three motivating factors, namely, Reputation, Liability, and Expense, influence hospital waste management. The survey for this study was conducted in two phases, with the pilot study used for exploratory factor analysis and the subsequent main survey used for cross-validation using confirmatory factor analysis. The hypotheses were validated through one-sample t tests. Correlations were established between the three motivating factors and organizational characteristics of hospital type, location, category, and size. The hypotheses were validated, and it was found that the factors of Liability and Expense varied considerably with respect to location and size of a hospital. The factor of Reputation, however, did not exhibit significant variation. In conclusion, concerns about the reputation of a facility and an apprehension of liability act as incentives for sound hospital waste management, whereas concerns about financial costs and perceived overburden on staff act as disincentives. IMPLICATIONS: This paper identifies the non economic motivating factors that can be used to encourage behavioral changes regarding waste management at hospitals in resource constrained environments. This study discovered that organizational characteristics such as hospital size and location cause the responses to vary among the subjects. Hence a policy maker must take into account the institutional setting before introducing a change geared towards better waste management outcomes across hospitals. This study covers a topic that has hitherto been neglected in resource constrained countries. Thus it can be used as one of the first steps to highlight and tackle the issue.

Reversible Experiments: Putting Geological Disposal to the Test.

Conceiving of nuclear energy as a social experiment gives rise to the question of what to do when the experiment is no longer responsible or desirable. To be able to appropriately respond to such a situation, the nuclear energy technology in question should be reversible, i.e. it must be possible to stop its further development and implementation in society, and it must be possible to undo its undesirable consequences. This paper explores these two conditions by applying them to geological disposal of high-level radioactive waste (GD). Despite the fact that considerations of reversibility and retrievability have received increased attention in GD, the analysis in this paper concludes that GD cannot be considered reversible. Firstly, it would be difficult to stop its further development and implementation, since its historical development has led to a point where GD is significantly locked-in. Secondly, the strategy it employs for undoing undesirable consequences is less-than-ideal: it relies on containment of severely radiotoxic waste rather than attempting to eliminate this waste or its radioactivity. And while it may currently be technologically impossible to turn high-level waste into benign substances, GD's containment strategy makes it difficult to eliminate this waste's radioactivity when the possibility would arise. In all, GD should be critically reconsidered if the inclusion of reversibility considerations in radioactive waste management has indeed become as important as is sometimes claimed.

The Central Importance of Laboratories for Reducing Waste in Biomedical Research.

The global biomedical research enterprise is driving substantial advances in medicine and healthcare. Yet it appears that the enterprise is rather wasteful, falling short of its true innovative potential. Suggested reasons are manifold and involve various stakeholders, such that there is no single remedy. In the present paper, I will argue that laboratories are the basic working units of the biomedical research enterprise and an important site of action for corrective intervention. Keeping laboratories relatively small will enable better training and mentoring of individual scientists, which in turn will yield better performance of the scientific workforce. The key premise of this argument is that people are at the heart of the successes and failures of biomedical research, yet the human dimension of science has been unduly neglected in practice. Renewed focus on the importance of laboratories and their constituent scientists is one promising approach to reducing waste and increasing efficiency within the biomedical research enterprise.

Specifying the Concept of Future Generations for Addressing Issues Related to High-Level Radioactive Waste.

The nuclear community frequently refers to the concept of "future generations" when discussing the management of high-level radioactive waste. However, this notion is generally not defined. In this context, we have to assume a wide definition of the concept of future generations, conceived as people who will live after the contemporary people are dead. This definition embraces thus each generation following ours, without any restriction in time. The aim of this paper is to show that, in the debate about nuclear waste, this broad notion should be further specified and to clarify the related implications for nuclear waste management policies. Therefore, we provide an ethical analysis of different management strategies for high-level waste in the light of two principles, protection of future generations-based on safety and security-and respect for their choice. This analysis shows that high-level waste management options have different ethical impacts across future generations, depending on whether the memory of the waste and its location is lost, or not. We suggest taking this distinction into account by introducing the notions of "close future generations" and "remote future generations", which has important implications on nuclear waste management policies insofar as it stresses that a retrievable disposal has fewer benefits than usually assumed.

Geological Disposal of Radioactive Waste: A Long-Term Socio-Technical Experiment.

In this article we investigate whether long-term radioactive waste management by means of geological disposal can be understood as a social experiment. Geological disposal is a rather particular technology in the way it deals with the analytical and ethical complexities implied by the idea of technological innovation as social experimentation, because it is presented as a technology that ultimately functions without human involvement. We argue that, even when the long term function of the 'social' is foreseen to be restricted to safeguarding the functioning of the 'technical', geological disposal is still a social experiment. In order to better understand this argument and explore how it could be addressed, we elaborate the idea of social experimentation with the notion of co-production and the analytical tools of delegation, prescription and network as developed by actor-network theory. In doing so we emphasize that geological disposal inherently involves relations between surface and subsurface, between humans and nonhumans, between the social, material and natural realm, and that these relations require recognition and further elaboration. In other words, we argue that geological disposal concurrently is a social and a technical experiment, or better, a long-term socio-technical experiment. We end with proposing the idea of 'actor-networking' as a sensitizing concept for future research into what geological disposal as a socio-technical experiment could look like.

Gestión de los residuos sanitarios en el ámbito hospitalario. Nivel de conocimiento y valoración Global / Sanitary waste in the hospital setting: Knowledge level and overall rating

Los residuos sanitarios representan un peligro potencial para los trabajadores sanitarios. Dado el alto riesgo de infección en los accidentes laborales, la gestión correcta de los residuos sanitarios minimiza el riesgo y mejora las condiciones laborales y ambientales. Objetivos. Identificar el nivel de conocimiento que tienen los profesionales sanitarios, en relación con la clasificación y gestión avanzada de los residuos sanitarios (RS) y valorar de forma global la gestión de los mismos. Metodología. Estudio descriptivo transversal con 178 participantes (auxiliares, enfermeras, médicos y técnicos de laboratorio), de 3 hospitales de la provincia de Barcelona. Se utilizó un cuestionario de elaboración propia, que analizabalas variables laborales, el conocimiento y la valoración global de la gestión de los RS. Resultados. El nivel medio de conocimiento sobre los RS delos auxiliares, las enfermeras, los médicos y los técnicos de laboratorio, en una escala de 1 (valor mínimo) a 15 (valor máximo), es de 10.59, 10.61, 8.92 y 8.39, respectivamente. La valoración global que hacen los auxiliares, las enfermeras, los médicos y los técnicos de laboratorio de la gestión de los RS en una escala de 1 (valor mínimo) y 5 (valor máximo), es de 2.89, 2.93, 2.88, 2.94, respectivamente. Conclusiones. Los resultados sugieren que las enfermeras y los auxiliares tienen un nivel de conocimiento aceptable con respecto a la gestión correcta de los RS. En cambio, los médicos y técnicos de laboratorio tienen un nivel de conocimiento inferiorsobre la segregación y eliminación adecuada de los RS. En cuanto a la valoración global, se obtienen valores aceptables, y muy similares, entre las diferentes categorías de profesionales estudiadas, en relación con la gestión correcta de los RS en los centros asistenciales donde realizan su actividad laboral (AU)

The sanitary waste represents a potential hazard for health workers. Given the high risk of infection in labor accidents, the correct management of sanitary waste minimizes this risk and improves labor and environment conditions. Objective. The current study was aimed at identifying the knowledge that health workers have about classification and management of sanitary waste. Methodology. The current study is a descriptive, cross-sectional study of 178 health workers (physicians, nurses, nurse assistants, lab technicians) of 3 hospitals in Barcelona. Results. Using a score from 1 (minimum) to 15 (maximum) to assess the knowledge, the average value for nurse assistants, nurses, physicians and lab technicians was 10.59, 10.61, 8.92 and 8.39, respectively. The global assessment of sanitary waste management (using a score from 1 to 5) was 2.89, 2.93, 2.88 and 2.94, respectively. Conclusions. These results suggest that nurses and nurse assistants have a good level of knowledge about the management of sanitary waste. By contrast, physicians and laboratory technicians have a lower level of knowledge compared to nurses and nurse asistants in relation to segregation and disposal of sanitary waste. Concerning the global assessment, the level is good, without differences between the different categories of health workers (AU)

Framing ethical acceptability: a problem with nuclear waste in Canada.

Ethical frameworks are often used in professional fields as a means of providing explicit ethical guidance for individuals and institutions when confronted with ethically important decisions. The notion of an ethical framework has received little critical attention, however, and the concept subsequently lends itself easily to misuse and ambiguous application. This is the case with the 'ethical framework' offered by Canada's Nuclear Waste Management Organization (NWMO), the crown-corporation which owns and is responsible for the long-term management of Canada's high-level nuclear fuel waste. It makes a very specific claim, namely that it is managing Canada's long-lived radioactive nuclear fuel waste in an ethically responsible manner. According to this organization, what it means to behave in an ethically responsible manner is to act and develop policy in accordance with its ethical framework. What, then, is its ethical framework, and can it be satisfied? In this paper I will show that the NWMO's ethical and social framework is deeply flawed in two respects: (a) it fails to meet the minimum requirements of a code of ethic or ethical framework by offering only questions, and no principles or rules of conduct; and (b) if posed as principles or rules of conduct, some of its questions are unsatisfiable. In particular, I will show that one of its claims, namely that it seek informed consent from individuals exposed to risk of harm from nuclear waste, cannot be satisfied as formulated. The result is that the NWMO's ethical framework is not, at present, ethically acceptable.

A Rawlsian approach to distribute responsibilities in networks.

Due to their non-hierarchical structure, socio-technical networks are prone to the occurrence of the problem of many hands. In the present paper an approach is introduced in which people's opinions on responsibility are empirically traced. The approach is based on the Rawlsian concept of Wide Reflective Equilibrium (WRE) in which people's considered judgments on a case are reflectively weighed against moral principles and background theories, ideally leading to a state of equilibrium. Application of the method to a hypothetical case with an artificially constructed network showed that it is possible to uncover the relevant data to assess a consensus amongst people in terms of their individual WRE. It appeared that the moral background theories people endorse are not predictive for their actual distribution of responsibilities but that they indicate ways of reasoning and justifying outcomes. Two ways of ascribing responsibilities were discerned, corresponding to two requirements of a desirable responsibility distribution: fairness and completeness. Applying the method triggered learning effects, both with regard to conceptual clarification and moral considerations, and in the sense that it led to some convergence of opinions. It is recommended to apply the method to a real engineering case in order to see whether this approach leads to an overlapping consensus on a responsibility distribution which is justifiable to all and in which no responsibilities are left unfulfilled, therewith trying to contribute to the solution of the problem of many hands.

Waste management to improve food safety and security for health advancement.

Economic growth inevitably influences the food chain. Growing demand with changes in lifestyle and health consciousness encourage use of packaged and pre-prepared foods. The needs of environmental protection from waste generated are largely overlooked, and a lack of knowledge about the impact on the environment and its health effects constitute food security/safety problems. Food production and waste generation directly affect resource (i.e., energy and water) consumption and often contaminate the environment. More pressure on food production has inculcated the use of pesticides, herbicides, antibiotics and chemical fertilizers which add to current global pollution. At least half of food grown is discarded before and after it reaches consumers. It is estimated that one third to half of landfill waste comes from the food sector. This landfill releases green house gases (GHG) as well as leachate which worsen soil and water quality and safety. Pharmaceutical and chemical contaminations from residential, industrial and agricultural sources make their way into nearby water and soil and can eventually affect our food systems. Phthalates, PFOA, BPA, commonly used in plastics and personal care products, are found in unacceptable concentrations in Taiwanese waters. They, too, contribute to food contamination and long-term health risk. Existing waste management strategies warrant more stringent norms for waste reduction at source. Awareness through education could reduce food waste and its consequences. This review encompasses impacts of food production systems on the environment, pollution which results from food waste, costs and economic advantages in food waste management, and health consequences of waste.

Errant corporations, diffuse responsibilities, and the environment: ethical issues in the Orica case study.

The papers in this volume deal with various aspects of the HCB legacy at the Orica plant at Botany. Whether explicitly or implicitly, they are concerned with questions of ethics; with the just distribution of burdens and benefits; with just processes for disposing of dangerous industrial waste; and with a just custodianship of the Botany environment. These ethical issues illustrate the difficulty of securing corporate accountability, and the elusiveness of responsibility within organisations. This paper reflects on some of the issues for ethics raised by the Orica case and their significance for corporate ethics.

Questioning nuclear waste substitution: a case study.

This article looks at the ethical quandaries, and their social and political context, which emerge as a result of international nuclear waste substitution. In particular it addresses the dilemmas inherent within the proposed return of nuclear waste owned by Japanese nuclear companies and currently stored in the United Kingdom. The UK company responsible for this waste, British Nuclear Fuels Limited (BNFL), wish to substitute this high volume intermediate-level Japanese-owned radioactive waste for a much lower volume of much more highly radioactive waste. Special focus is given to ethical problems that they, and the UK government, have not wished to address as they move forward with waste substitution. The conclusion is that waste substitution can only be considered an ethical practice if a set of moderating conditions are observed by all parties. These conditions are listed and, as of yet, they are not being observed.