Using an Environmentally Friendly Disposal Bag to Discard Leftover Opioids After Gynecologic Surgery.

OBJECTIVE: To evaluate the effects of an environmentally friendly drug deactivation bag on opioid disposal among patients undergoing gynecologic surgery. METHODS: This prospective cohort study included patients undergoing gynecologic procedures requiring an opioid prescription from March 2020 to December 2020. Patients were managed on a restrictive opioid prescribing algorithm and given an opioid disposal bag. The carbon drug deactivation bag neutralizes the opioid medication and can be discarded safely in the trash. Patients were educated about pain management goals and the disposal bag. Patients were surveyed at their postoperative visit to evaluate satisfaction, number of leftover pills, and disposal methods. Statistical analysis was performed using SPSS Statistics 26. RESULTS: Two hundred patients were asked to complete the survey, with a response rate of 78%. The most common procedures were exploratory laparotomy (50%) and minimally invasive hysterectomy (41%). Most patients (91%, 95% CI 91-97) filled their opioid prescription and 64 (41%, 95% CI 34-48) had leftover opioid pills. Most patients with leftover opioid pills (73%, 95% CI 67-79) discarded them; 78%, 95% CI 69-80 used the disposal bag. Patients undergoing an exploratory laparotomy most commonly used the disposal bag. All patients who used the disposal bag stated they would use it again. CONCLUSION: Despite a restrictive opioid prescribing algorithm, 41% of gynecologic surgical patients had leftover opioid pills. This study demonstrated that leftover opioid pills were safely discarded 73% of the time when patients were provided an opioid disposal bag and preoperative education.

A self-powered insulin patch pump with a superabsorbent polymer as a biodegradable battery substitute.

Highly popular insulin patch pumps have in-built non-removable batteries. These batteries are routinely disposed of together with the used pumps as medical waste and end up in landfills. This is an environmental contamination conundrum by design. To address this issue, we proposed a self-powered patch pump that uses a biodegradable superabsorbent polymer (SAP) instead of a battery as a power source to drive the infusion. Continuous infusion rates from 6.1 µL min-1 to 49.1 µL min-1 were achieved. Together with valve throttling, basal and bolus infusion rates of ∼10 µL h-1 (1 U h-1) and 100 µL (10 U) in ∼11 min could also be implemented for glycemic control. The generated pressure at ∼0.7 psi is also adequate for infusion as it exceeded an adult's maximum peripheral venous pressure of 0.6 psi. Given the current number of patch pump users, the proposed design could prevent ∼100 000 used batteries from entering the medical waste stream and landfill daily. Most importantly, this work highlights the possibility of addressing environmental contamination without compromising on healthcare standards by using SAP as an alternative means of energy storage.

Situational Assessment of Functional Elements, Practices Adopted & Concerns Related to Bio Medical Waste Management in City of Pune, India.

The study was conducted with the objective of leading a situational assessment of Pune city with regard to Bio medical waste management, exploring knowledge, attitude & practices (KAP) of healthcare workers, and identifying challenges of stakeholders. Results revealed 69.2% of the hospitals had a biomedical waste management facility. Facilities like incineration, shredder, sharp pit, encapsulation, deep burial, and chemical disinfection were non- existing in 60% to 90% of hospitals. Bivariate analysis on questions with the type of employees and (KAP) was calculated. The utilization of the existing services and noncompliance are the major findings from the study.

Three-dimensional batch electrochemical coagulation (ECC) of health care facility wastewater-clean water reclamation.

Three-dimensional (3D) batch ECC of raw health care facility wastewater (HCFWW) was adopted using stainless steel (SS) and aluminum (Al) scrap metal particle electrodes. ECC treatment was focused on priority quality parameters viz., chemical oxygen demand (COD), color, and other important water quality parameters. Sludge settling and filterability for post-ECC slurry were investigated after ECC. COD removals of 87.56 and 87.2% were achieved for current densities (CD) 83.33 and 125 A/m2 using SS-3D electrodes, and similarly, 86.99 and 86.23% COD removal for Al-3D electrodes. Simultaneously, color removals were 88.50 and 87.60% for CD 166.66 A/m2 (4A) using SS and Al-3D electrodes. Water quality parameters viz., nitrate, phosphates, and sulfate were also removed by 93.18%, 96.83%, and 41.07% for SS-3D electrodes, while Al-3D electrodes showed 93.15%, 96.72%, and 25.94% removal. Post-ECC slurry settling was good for all the applied CD using SS-3D electrodes generating dense and sturdy flocs. Al-3D electrodes showed excellent floc settling properties. SS-3D electrode flocs displayed good filterability at 1A with α: 2.497 × 1011 m kg-1 and Rm 1.946 × 1010 m-1. Post-ECC slurry using Al-3D electrodes were viscous causing delayed filterability giving α: 1.1760 × 1011 m kg-1 and Rm 1.504 × 109 m-1 for 3A. E. coli was destroyed by 97 and 98% for 2A and 3A respectively. Clear water reclamation of 85-90% and pollutants/contaminants removed within a short HRT of 75 min proved the effectiveness of adopting 3D-ECC for treating raw HCFWW.

Synergistic effect of activated carbon and encapsulated trace element additive on methane production from anaerobic digestion of food wastes - Enhanced operation stability and balanced trace nutrition.

Laboratory semi-continuous anaerobic digestion (AD) experiments were performed to investigate the effects of different supplements on the AD performance of food waste, specifically activated carbon (AC), encapsulated trace element additive (ETEA) and a combination of AC + ETEA. Results indicated that the operation stability of AD was enhanced through the addition of the additives. Compared with the control digester without any additive, AC, ETEA, and AC + ETEA increased the average methane yield by 34%, 22% and 50%, respectively. Chemical speciation analyses indicated that AC + ETEA supplementation increased the proportion of water soluble form of Ni by 11-23%, compared to ETEA single addition. Real-time PCR analyses showed that AC and ETEA supplementation synergistically facilitated the growth of bacterial and archaeal communities. Microbial community structure analysis revealed that AC + ETEA favored the enrichment of hydrolytic, acidogenic and acetogenic bacteria and methanogens.

Descarte de medicamentos: uma questão socioambiental e de saúde / Medicine dispoasal: a socio-enviromental and health issue / Descarte de medicamentos: una cuestión socioambiental y de salud

Objetivo: Descrever como é realizado o descarte de medicamentos; avaliar o conhecimento de profissionais que atuam em Unidades de Saúde da Família a respeito do descarte de medicamentos. Método: Pesquisa qualitativa, exploratória, descritiva, realizada com 16 profissionais em quatro Unidades de Saúde da Família de um município do sul do Brasil. A coleta ocorreu por meio de entrevistas semiestruturadas. A análise dos dados foi por meio da análise textual discursiva. Resultados: Os trabalhadores não cumprem os passos do descarte correto. A maioria desconhece a legislação vigente. Os profissionais identificaram a contaminação do meio ambiente, uso indevido dos medicamentos descartados incorretamente e resistência bacteriana aos medicamentos como as principais consequências do descarte incorreto. Conclusão: Esta pesquisa pode contribuir na gestão e na assistência, fazendo com que gestores, profissionais e usuários repensem o seu fazer, melhorando a saúde das pessoas e do meio ambiente

Objectives: Describe how the disposal of drugs is carried out; To evaluate the knowledge of professionals working in Family Health Units regarding drug disposal. Methods: Qualitative, exploratory, descriptive research, carried out with 16 professionals in four Family Health Units of a municipality in the south of Brazil. The collection took place through semi-structured interviews. The analysis of the data was through discursive textual analysis. Results: Workers do not follow the steps of the correct disposal, most are unaware of the current legislation, the professionals identified the contamination of the environment, misuse of incorrectly discarded drugs and bacterial resistance to medications as the main consequences of incorrect disposal. Conclusions: This research can contribute to the management and assistance, making managers, professionals and users rethink their doing, improving the health of people and the environment

Objetivos: Describir como es realizado lo descarte de medicamentos; evaluar el conocimiento de profesionales que actúan en Unidades de Salud de la Familia acerca del descarte de medicamentos. Métodos: Investigación cualitativa, exploratório, descriptiva, realizada con 16 profesionales en cuatro Unidades de Salud de la Familia de un municipio del sur del Brasil. La recolección ocurrió por medio de entrevistas semi-estructuradas. El análisis de los datos fue por medio del análisis textual discursiva. Resultados: Los trabajadores no cumplen los pasos del descarte correcto, la mayoría desconoce la legislación vigente, los profesionales identificaron la contaminación del medio ambiente, uso indebido de los medicamentos descartados incorrectamente y resistencia bacteriana a los medicamentos como las principales consecuencias del descarte incorrecto. Conclusiones: Esta investigación puede contribuir en la gestión y en la asistencia haciendo con que, gestores, profesionales y usuarios replanteen su hacer, mejorando la salud de las personas y del medio ambiente

A new strategy to control the proliferation of microorganisms in solid hospital waste and the diffusion of nosocomial infections.

A possible tool to reduce nosocomial infections is to identify unknown sources of contamination and then to provide a measure for controlling the related infections. In this study, solid hospital waste was considered a potential source of contamination, and a strategy to reduce the potential risk of pathogen contamination was tested. This paper describes a novel technique for waste management in healthcare settings with a view to facilitating infection prevention and control. We explored the innovative use of sodium dichloroisocyanurate (NaDCC) by investigating the microbicidal activity of chlorine, which derives from the hydrolysis of NaDCC mediated by humidity, and by testing its effect on the inhibition of microorganism growth. NaDCC was inserted in a solid hospital waste bin containing also Lauria-Bertani agar plates, with different dilutions of a known titre of three different microorganisms, namely Escherichia coli, Staphylococcus aureus and Aspergillus brasiliensis. The plates were incubated in the container with or without the antimicrobial agent (control, CNT) at room temperature for 5 days. The number of colony-forming units (CFUs) present on each plate was then counted. Microorganisms capable of proliferating in the CNT waste bin were not able to grow in the presence of NaDCC. Furthermore, the molecular chlorine which developed and was released in the waste bin under the experimental conditions (T=20°C, t=5 days) was quantified using iodometric titration. NaDCC hydrolysis, mediated by humidity, has a strong and long-lasting microbicide effect. The proliferation of tested bacteria and fungi is totally inhibited. These results demonstrate the effectiveness of NaDCC in controlling and/or inhibiting microbial proliferation and support its possible use in the treatment of hospital waste to control the spread of nosocomial contamination.

Assessment of Healthcare Waste Management Paradigms and Its Suitable Treatment Alternative: A Case Study.

The management and treatment of healthcare waste (HCW) are of great concern owing to its potential hazard to human health and the environment, particularly in developing countries. Nowadays, various technological alternatives are gaining momentum as efficient and favorable waste management options across the world. However, selecting a suitable technology as well as an effective waste management approach for the treatment of HCW is still a challenging task for the municipal authorities. This study renders a comprehensive analysis of healthcare waste management (HCWM) practices and the technological options for its better management through a case study in Khulna, the southwestern division of Bangladesh. A number of healthcare establishments (HCEs) in the study area were selected and a questionnaire survey, as well as field investigations, was performed to find out the present status of HCWM and its limitations. An assessment of different technological alternatives was also carried out using Sustainability Assessment of Technologies (SAT) methodology which could pave the way for treating hazardous waste more efficiently in the Khulna metropolitan area. The study revealed that the overall HCW generation rate and hazardous HCW generation rate in Khulna city were 0.90 kg bed-1 day-1 and 0.18 kg bed-1 day-1, respectively. Assessment of management system revealed that 56% (n = 38) of workers did not receive any form of training in the handling of hazardous waste. Around 54% (n = 47) of them did not use any safety equipment or clothing. It has been found from the study that, among different technological alternatives based on the final score, incineration was the most suitable option for the treatment of hazardous waste in Khulna. Finally, some guidelines have been put forward to improve its existing management practices.

General Hospital and Personal Use Devices; Reclassification of Sharps Needle Destruction Device. Final order.

The Food and Drug Administration (FDA or the Agency) is issuing a final order to reclassify the needle destruction device, renaming the device to "sharps needle destruction device, a postamendments class III device (regulated under product code MTV), into class II (special controls), subject to premarket notification. FDA is also identifying the special controls that the Agency believes are necessary to provide a reasonable assurance of safety and effectiveness of the device. FDA is finalizing this reclassification on its own initiative based on new information. The Agency is classifying the device into class II (special controls) to provide a reasonable assurance of safety and effectiveness of the device. This order reclassifies these types of devices from class III to class II and will reduce regulatory burdens on industry because these types of devices will no longer be required to submit a premarket approval application (PMA), but can instead submit a less burdensome premarket notification (510(k)) before marketing their device.

Biogas Production from Distilled Grain Waste by Thermophilic Dry Anaerobic Digestion: Pretreatment of Feedstock and Dynamics of Microbial Community.

Distilled grain waste (DGW) eluted from the Chinese liquor making process poses potential serious environmental problems. The objective of this study is to evaluate the feasibility of converting DGW to biogas by thermophilic dry anaerobic digestion. To improve biogas production, the effects of dilute H2SO4 and thermal pretreatment on DGW were evaluated by biochemical methane potential (BMP) tests. The results indicate that 90 °C thermal pretreatment provided the highest methane production at 212.7 mL/g-VTSadd. The long-term thermophilic dry anaerobic digestion process was conducted in a 5-L separable flask for more than 3 years at a volatile total solid (VTS) loading rate of 1 g/kg-sludge/d, using synthetic waste, untreated and 90 °C thermal pretreated DGW as the feedstock, respectively. A higher methane production, 451.6 mL/g-VTSadd, was obtained when synthetic waste was used; the methane production decreased to 139.4 mL/g-VTSadd when the untreated DGW was used. The 90 °C thermal pretreated DGW increased the methane production to 190.5 mL/g-VTSadd, showing an increase of 36.7% in methane production compared with that using untreated DGW. The microbial community structure analysis indicates that the microbial community in the thermophilic dry anaerobic digestion system maintained a similar structure when untreated or pretreated DGW was used, whereas the structure differed significantly when synthetic waste was used as the feedstock.

Effect of aeration rate, moisture content and composting period on availability of copper and lead during pig manure composting.

Pollution by heavy metals, such as copper and lead, has become a limiting factor for the land application of faecal manures, such as pig manure. This study was conducted to investigate the influence of composting process parameters, including aeration rate, moisture content and composting period, on the distribution of heavy metal species during composting, and to select an optimal parameter for copper and lead inactivation. Results showed that the distribution ratios of exchangeable fractions of copper and lead had a bigger decrease under conditions of aeration rate, 0.1 m(3) min(-1) m(-3), an initial moisture content of 65% and composting period of 50 days. Suboptimal composting process conditions could lead to increased availability of heavy metals. Statistical analysis indicated that the aeration rate was the main factor affecting copper and lead inactivation, while the effects of moisture content and composting period were not significant. The rates of reduction of copper-exchangeable fractions and lead-exchangeable fractions were positively correlated with increased pH. The optimal parameters for reducing heavy metal bioavailability during pig manure composting were aeration rate, 0.1 m(3) min(-1) m(-3), initial moisture content, 65%, and composting period, 20 days.

Thermal treatment of medical waste in a rotary kiln.

This paper presents the results of a study of an experimental system with thermal treatment (incineration) of medical waste conducted at a large complex of hospital facilities. The studies were conducted for a period of one month. The processing system was analysed in terms of the energy, environmental and economic aspects. A rotary combustion chamber was designed and built with the strictly assumed length to inner diameter ratio of 4:1. In terms of energy, the temperature distribution was tested in the rotary kiln, secondary combustion (afterburner) chamber and heat recovery system. Calorific value of medical waste was 25.0 MJ/kg and the thermal efficiency of the entire system equalled 66.8%. Next, measurements of the pollutant emissions into the atmosphere were performed. Due to the nature of the disposed waste, particular attention was paid to the one-minute average values of carbon oxide and volatile organic compounds as well as hydrochloride, hydrogen fluoride, sulphur dioxide and total dust. Maximum content of non-oxidized organic compounds in slag and bottom ash were also verified during the analyses. The best rotary speed for the combustion chamber was selected to obtain proper afterburning of the bottom slag. Total organic carbon content was 2.9%. The test results were used to determine the basic economic indicators of the test system for evaluating the profitability of its construction. Simple payback time (SPB) for capital expenditures on the implementation of the project was 4 years.

Impact of pedagogical method on Brazilian dental students' waste management practice.

The purpose of this study was to conduct a qualitative analysis of waste management practices among a group of Brazilian dental students (n=64) before and after implementing two different pedagogical methods: 1) the students attended a two-hour lecture based on World Health Organization standards; and 2) the students applied the lessons learned in an organized group setting aimed toward raising their awareness about socioenvironmental issues related to waste. All eligible students participated, and the students' learning was evaluated through their answers to a series of essay questions, which were quantitatively measured. Afterwards, the impact of the pedagogical approaches was compared by means of qualitative categorization of wastes generated in clinical activities. Waste categorization was performed for a period of eight consecutive days, both before and thirty days after the pedagogical strategies. In the written evaluation, 80 to 90 percent of the students' answers were correct. The qualitative assessment revealed a high frequency of incorrect waste disposal with a significant increase of incorrect disposal inside general and infectious waste containers (p<0.05). Although the students' theoretical learning improved, it was not enough to change behaviors established by cultural values or to encourage the students to adequately segregate and package waste material.

Application of interval 2-tuple linguistic MULTIMOORA method for health-care waste treatment technology evaluation and selection.

The management of health-care waste (HCW) is a major challenge for municipalities, particularly in the cities of developing countries. Selection of the best treatment technology for HCW can be viewed as a complicated multi-criteria decision making (MCDM) problem which requires consideration of a number of alternatives and conflicting evaluation criteria. Additionally, decision makers often use different linguistic term sets to express their assessments because of their different backgrounds and preferences, some of which may be imprecise, uncertain and incomplete. In response, this paper proposes a modified MULTIMOORA method based on interval 2-tuple linguistic variables (named ITL-MULTIMOORA) for evaluating and selecting HCW treatment technologies. In particular, both subjective and objective importance coefficients of criteria are taken into consideration in the developed approach in order to conduct a more effective analysis. Finally, an empirical case study in Shanghai, the most crowded metropolis of China, is presented to demonstrate the proposed method, and results show that the proposed ITL-MULTIMOORA can solve the HCW treatment technology selection problem effectively under uncertain and incomplete information environment.