Waste generated by the health care industry has been cited as a major source of toxic pollution, including mercury and dioxins, which poses a serious threat to public health. The purpose of this study was to investigate pollution prevention activities of health care facilities in Oregon related to environmentally preferable purchasing practices, recycling, mercury reduction efforts, and written policy. Surveys were sent to 57 hospitals in Oregon, 24 facilities responded (42.1 %). Results indicate that the following environmentally-preferable purchasing practices are being implemented: purchasing reduced hazardous material (92%); using recycled packaging (75%); and, using products made from recycled content material (83%). Other practices, such as the purchasing of cadmium-free red bags (25%), supplies shipped in reusable shipping containers (34%), and using minimal packaging (46%) are being implemented in a few hospitals. None of the hospitals are purchasing chlorine-free office paper. The majority of participating Oregon hospitals are recycling paper (96%), cardboard (96%), clear glass (67%), linens (87.5%), batteries (67%) and X-ray film (83%). Fewer hospitals are recycling plastics: #1 PET and #6 polystyrene (37.5%), #2 HDPE (42%), #5 polypropylene (33%). Fewer hospitals are also composting food (46%), computers and equipment (42%), fluorescent lamps (21%) and solvents/fixers (29%). Major barriers to recycling in hospitals include lack of established markets for some materials, limited space to collect the materials, and low employee participation. The majority of participating hospitals are reducing the purchasing of mercury containing products, replacing mercury blood pressure units and gauges, replacing lab and housekeeping chemicals, and pharmaceuticals. Fewer than 50% of then participating hospitals are replacing switches, recycling batteries and conducting an inventory of mercury sources. Few hospitals are checking drains and pipes for mercury contamination (13%), recycling fluorescent lamps (21%) and requiring vendors to disclose mercury content below 1% (17%). While most hospitals no longer purchase new mercury-containing devices, the cost associated with disposal of mercury as a hazardous waste is a major barrier to elimination. Hospitals located in urban areas in Oregon are more likely to implement pollution prevention strategies than rural hospitals. Nearly all Oregon hospitals lack a corporate policy on pollution prevention/source reduction, or written goals on waste volume reduction or waste toxicity reduction efforts. The few hospitals (8%) that have put policies in place have done so voluntarily, and with the full support from upper-level management. Based on theses findings recommendations include the following: 1) Establish a "Green Team" of hospital staff from diverse departments. This group can then strategize about courses of action for the facility with input from all responsible sectors. 2) Conduct a waste audit. This establishes a baseline of existing hospital waste and will help determine how to shape a waste minimization program and pollution prevention plan. 3) Pollution prevention education should be a top priority for all departments within each hospital including purchasing, nursing, housekeeping and top management. Many health care professionals are not aware of the link between the products and practices they choose and the environmental consequences of these choices. 4) Rural hospitals can join pollution prevention email list serves such as the Oregon Health Care Without Harm list (HCWHoregon-health.org) or the H2E list serve (www.h2e-online.org) to share, learn and identify practical strategies for pollution prevention and waste minimization. 5) Approach and involve upper level management to work with hospital "green teams" to develop and implement a hospital policy on pollution prevention. / Graduation date: 2003

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

Submitted in accordance with the requirements for the Doctors Degree of Technology: Business Administration, Durban University of Technology, 2009. / Although there is an abundance of health care waste information in South Africa, not enough studies have been done in public district hospitals particularly in rural areas. Hospitals find it difficult to comply with the minimum requirements of health care waste management guidelines, such as segregation of waste. If hazardous waste gets mixed with non-hazardous waste, waste disposal and treatment become costly. Furthermore, there has been a sharp increase in the amount of waste generated from health facilities. However, there seem to be uncoordinated efforts in each province in dealing with waste problems. The purpose of this study was to evaluate the process of operational and administrative procedures of health care waste management in hospitals. The study was conducted to facilitate the optimisation of waste management. A quantitative approach was chosen for this study because cause and effect relationships can more easily be identified, and the research is more structured and controlled. The project involved an enquiry into the perception of respondents on the procedures used in managing health care waste. Data was collected from 270 respondents out of 27 hospitals in nine provinces of South Africa. The informants were health care waste workers who were either directly or indirectly involved in waste management. A questionnaire was used as a research instrument. Results were analysed statistically using a special package for scientific studies. It has been found that in the midst of financial challenges, hospitals are unable to prioritise and rank absolutely important activities that are necessary to be undertaken to meet minimum requirements of health care waste management as laid out in the health care waste guidelines and directives. Shortages of waste equipment such as trolleys, waste containers, and temporary storage areas were the main challenges facing hospitals. The recommendations set the tone and provide a blueprint that health care managers may consider in facilitating improvement in the management of health care waste.

published_or_final_version / Environmental Management / Master / Master of Science in Environmental Management

Graduation date: 1994

Orientador: Li Li Min / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-16T04:54:04Z (GMT). No. of bitstreams: 1 Eid_NayeneLeocadiaManzutti_D.pdf: 3371365 bytes, checksum: c5958487d4a3f2d1c58e3f284b78b334 (MD5) Previous issue date: 2010 / Resumo: Embora o avanço tecnológico tenha viabilizado o uso dos sistemas digitais para a aquisição de imagens radiográficas, ainda hoje, no Brasil, os filmes radiográficos convencionais continuam sendo os tipos de receptores mais utilizados nos consultórios odontológicos. Deste modo, após a exposição aos raios X, os filmes radiográficos devem ser processados em soluções químicas a fim de que a imagem latente seja convertida em imagem real, passível de análise para diagnóstico. Sabe-se que, tanto o revelador quanto o fixador radiográfico contém em sua composição substâncias químicas altamente tóxicas, podendo apresentar risco à saúde de profissionais, que podem desenvolver lesões cutâneas e dermatites em decorrência do manuseio e manipulação destas soluções de processamento, além de apresentarem risco à saúde pública, caso ocorra a ingestão de produtos oriundos do meio ambiente previamente contaminado e ainda, sérios prejuízos ao meio ambiente, contaminação da fauna e flora, em virtude do descarte indevido destas soluções após seu uso. Tendo isto em vista, os objetivos deste trabalho foram: 1) Avaliar a eficácia de um novo modelo de recipiente para processamento radiográfico manual em câmara-escura portátil, para uso em consultórios odontológicos; 2) Avaliar qualitativamente e quantitativamente as imagens radiográficas obtidas por meio do processamento radiográfico nos diferentes recipientes; 3) Comparar os resultados obtidos em ambas as análises; sob a hipótese de que, devido às suas configurações geométricas, este novo modelo de recipiente propiciaria a economia de soluções químicas para que a execução do processamento radiográfico manual, reduziria os custos aos profissionais da área odontológica e, além disto, promoveria a redução do impacto ambiental devido à minimização da quantidade de químicos usados nestes recipientes. Para atender aos objetivos e conhecer sobre a aplicabilidade deste trabalho, realizou-se um outro estudo no qual se fez uma investigação sobre o descarte dos Resíduos de Serviço de Saúde produzidos em consultórios odontológicos localizados no Estado do Tocantins, Brasil. O estudo abordou aspectos relacionados ao conhecimento e atitudes dos cirurgiões dentistas frente aos resíduos gerados em seu ambiente de trabalho, e sua percepção sobre os resíduos gerados nos demais consultórios odontológicos. Um questionário foi aplicado a 239 cirurgiões-dentistas. Destes, 78,2% trabalhavam em clínica particular e 68,6% já haviam cursado alguma pós-graduação. Do total dos entrevistados, 87,9% afirmaram realizar exames radiográficos em seu consultório e estes foram unânimes em afirmar que o processamento das imagens era realizado manualmente em câmara-escura portátil e a maioria dos entrevistados (88,1%) afirmou que, em média, a cada 5 dias, descartava no esgoto as soluções químicas de processamento utilizadas. Ademais, 30,1% dos participantes acreditavam que os resíduos de amálgama eram descartados, por outros profissionais, em lixo comum e outros 8,8% supunham que o descarte era feito na pia dos consultórios; 61,9% acreditavam que o lixo contaminado (infectante) era disposto juntamente com o lixo comum e, em relação os resíduos perfurocortantes, 14,2% acreditavam que eram descartados em recipientes plásticos e 9,2% em lixo comum. Por meio deste trabalho, concluiu-se, que, em geral, os cirurgiões-dentistas entrevistados desconheciam sobre o correto descarte dos resíduos de serviço de saúde, uma vez que foi observada negligência desta prática por muitos deles, além da percepção de que outros profissionais também realizavam o descarte incorreto dos resíduos gerados em seu ambiente de trabalho. De posse destas informações, testou-se um novo modelo de recipiente para processamento radiográfico manual. Foram obtidas imagens radiográficas dos dentes posteriores de um phantom de mandíbula humana macerada e em seguida, estas imagens foram processadas em quatro câmaras-escuras portáteis. Em uma delas foram colocados dois recipientes convencionais (R1) abastecidos com 200ml das soluções de processamento e, em cada uma das demais câmaras-escuras, para este mesmo propósito, foi disposto um par de cada um dos três tipos de recipientes desenvolvidos pelos autores, R2, R3 e R4, abastecidos com 12, 19,2 e 24ml das soluções reveladora e fixadora respectivamente. Foram processadas 184 películas em R1, 40 em R2, 48 em R3 e 56 em R4. As películas radiográficas foram digitalizadas e posteriormente submetidas à análise objetiva no programa MaZda; em seguida, foram dispostas de maneira ordenadas, obedecendo a sequência do processamento, em papel cartão preto, para que pudessem ser submetidas à análise subjetiva. Os resultados da análise subjetiva mostraram que houve concordância dentre os cinco examinadores em relação às imagens consideradas aceitáveis para diagnóstico para os quatro recipientes estudados, e os resultados da análise objetiva mostraram que as imagens foram consideradas satisfatórias para diagnóstico até o 15º dia de pesquisa para R1, até o 4º dia para R2 e R3, e 5º dia para R4. A análise subjetiva mostrou-se menos sensível que a objetiva na avaliação da qualidade das imagens radiográficas processadas nos recipientes convencionais (R1), porém, mostrou grande correlação com a objetiva na avaliação da qualidade das imagens processadas nos demais recipientes (R2, R3 e R4). Deste modo, concluiu-se que o novo modelo de recipiente viabilizou o processamento de películas radiográficas em câmara-escura portátil, utilizando menor quantidade de soluções químicas para o processamento radiográfico manual, sendo que estas se apresentaram com qualidade satisfatória para diagnóstico. / Abstract: Even though the technological advances have allowed the utilization of digital systems for acquisition of radiographic images, conventional radiographic films are still the most used in dental offices in Brazil. Thus, after X-ray exposure, the radiographic films must be processed in chemical solutions to change the latent stored images into visible images for diagnostic purposes. Both the developer and fixer contain highly toxic chemical substances that may endanger the health of professionals, who may present skin lesions and dermatitis due to handling of these solutions. These chemicals may also constitute a public health problem if contaminated products of the environment are ingested, besides posing serious risks to the environment by contamination of the fauna and flora if these chemical solutions are improperly discarded after utilization. Therefore, this study aimed to: 1) evaluate the efficacy of a new container for manual radiographic processing in portable darkrooms for utilization in dental offices; 2) qualitatively and quantitatively evaluate the radiographic images obtained by radiographic processing in the different containers; 3) compare the results obtained in both analyses, considering that the design of the new container would allow dental professionals to save the chemical solutions used for manual radiographic processing, reducing the costs and also the environmental impact, considering the minimization of the quantity of chemical solutions used in these containers. To meet these objectives and know the applicability of this study, a previous study was conducted in which we investigated the discard of Health Service Wastes produced in dental offices of the state of Tocantins, Brazil. The study discussed the aspects related to the knowledge, perception and attitudes of dentists towards the waste generated in their work environment. We interviewed 239 dentists using a structured questionnaire, of whom 78.2% worked at private offices and 68.6% had post-graduate degree. From the total of respondents, 87.9% stated that they did perform intraoral radiographic exams in their offices, and these professionals unanimously used portable dark rooms from commercial brands for radiographic processing. Most dentists (88.1%) that perform radiographic exams in their offices declared that the mean period for changing the radiographic processing chemicals was 5 days. Conversely, 30.1% of participants believed that amalgam wastes were discarded in common garbage, and 8.8% believed that amalgam wastes were discarded in the offices' sink; 61.9% of them believed that the infectious waste were discarded together with the common garbage. Regarding the sharp objects, 14.2% believed that these were discard in plastic recipients, and 9.2% believed that the majority of dentists discarded sharp objects in the common garbage. The data obtained in this study revealed that, in general, the dentists interviewed were unaware of the correct procedures for the discard of health service waste, since there was both negligence in these practices by many of them and the perception that other professionals also performed incorrect discard of waste generated in their work environment. After achievement of these data, a new model of container for manual radiographic processing was tested. Radiographic images were obtained from the posterior teeth of a phantom dry human mandible and processed in four portable darkrooms. One darkroom had two conventional containers (R1) filled with 200ml of processing solutions. For the same purpose, each of the other darkrooms had one pair of the three types of containers designed by the authors, namely R2, R3 and R4, filled with 12, 19.2 and 24ml of developing and fixer solutions. A total of 184 films were processed in R1, 40 in R2, 48 in R3 and 56 in R4. The films were digitized and objectively analyzed using the software MaZda; following, they were arranged according to the sequence of processing in black cardboards for subjective analysis. The results of the subjective analysis revealed good agreement between the five examiners concerning the images considered acceptable for diagnosis for all four containers investigated. The results of the objective analysis demonstrated that the images were considered satisfactory for diagnosis until the 15th day of investigation for R1, fourth day for R2 and R3, and fifth day for R4. The subjective analysis was less sensitive than the objective analysis to evaluate the quality of radiographic images processed in the conventional containers (R1), yet presented high correlation with the objective analysis for evaluation of the quality of images processed in the other containers (R2, R3 and R4). Thus, it was concluded that the new model of container allowed processing of radiographic films in portable darkrooms using a smaller quantity of chemical solutions for manual radiographic processing and presenting satisfactory quality for diagnosis. / Doutorado / Neurocirugia / Doutor em Fisiopatologia Medica

Thesis (MPH.) -- University of Limpopo, 2016. / Background: Health care workers produce various types of waste in the course of rendering health care services. Each classification of waste must be disposed according to the prescribed guidelines. Improper disposal of waste may pose a danger to employees, patients and the environment. Health care workers must have adequate knowledge on disposal of medical waste. This study was therefore done to determine the knowledge and practices of health care workers on medical waste disposal. Objectives: This study aims to determine the knowledge and practices of health care workers on medical waste disposal at a hospital in the Mpumalanga Province in South Africa. Methods: A quantitative cross-sectional research approach was used at a regional hospital for the Mpumalanga Province in the Bushbuckridge Municipality under the Ehlanzeni District. The study respondents included professional nurses, enrolled nurses, enrolled nursing assistants, medical doctors, dental health and allied health staff. Data were collected through self-administered questionnaires analysed using International Business Management Statistical Package for Social Sciences 22 (IBM SPSS 22). Results: The results show that a high percentage of health care workers did not have adequate knowledge regarding disposal of medical waste but disposed medical waste appropriately. The results further show that knowledge and practice of health care workers had no association with age, gender and years of experience. There is an association between professional category and knowledge and practice of healthcare workers. Conclusion: Disposal of medical waste is the responsibility of all health care workers. There should be regular training of all categories of health care workers to improve their knowledge on disposal of medical waste and minimise the risks associated with improper waste management. This will further increase compliance with the guidelines of disposal of medical waste. Key words: Health care workers, medical waste, knowledge, practice, disposal

Thesis (MTech (Environmental Health))--Cape Peninsula University of Technology, 2011. / Pharmaceuticals have been formulated to influence physiological systems in humans, animals, and microbes but have never been considered as potential environmental pollutants by healthcare professionals. The human body is not a barrier to chemicals, but is permeable to it. Thus after performing their in-vivo functions, pharmaceutical compound introduced into the body, exit mainly via urine and faeces. Sewage therefore contains highly complex mixtures of chemicals in various degrees of biological potency. Sewage treatment works including those in South Africa, on the other hand, are known to be inefficient in removing drugs from sewage and consequently either the unmetabolised pharmaceutical compounds or their metabolites emerge in the environment as pollutants via several trajectories. In the environment, the excreted metabolites may even undergo regeneration to the original parent molecule under bacterial influence, resulting in "trans-vivo-pharmaceutical-pollution-cycles". Although all incinerators are known to generate toxins such dioxins and furans from the drugs they incinerate, all the medicines disposed by the hospitals under research, were incinerated, as the preferred option of disposal. The incineration process employed was found to be environmentally unsafe. Expired and unused medicines which the general public discard as municipal solid waste become landfilled. Because many landfill sites are not appropriately engineered, the unwanted drugs landfilled therein, leach into the surrounding ground water, which is the influent source of water treatment plants. Water treatment plants, including those in South Africa, are also inefficient in eliminating pharmaceutical compounds, releasing them in sub-therapeutic concentrations into potable tap water as pollutants, the full effects of which are yet to be determined.

Thesis (MPH.) -- University of Limpopo, 2016 / Introduction The aim of the study was to determine the knowledge and practices of health care workers on medical waste disposal at George Masebe Hospital, Waterberg District, Limpopo Province, South Africa. Method A cross sectional study was conducted and simple random sampling was used to select participants. Data was collected using self-administered questionnaire which where total of 141 participants were sampled using the Slovin formula. Data were analyzed using the IBM SPSS Version 22 and both descriptive and inferential statistics were used to answer the study objectives. Results The study shows that 43% of the respondents had good knowledge on medical waste disposal, 13% were not sure and 44% had insufficient knowledge. Forty nine percent (49%) of the respondents practiced safe medical waste disposal, 4, 3% were moderate in practice and 46, 1% had insufficient practice in place. There was no statistical significant relationship between knowledge and practice of medical waste disposal control measures of health care workers. Conclusion The study concluded that knowledge of the respondents on medical waste disposal was insufficient, there were satisfactory medical waste practices and there was no relationship between knowledge and practice.

Thesis (MTech(Environmental Health))--Cape Peninsula University of Technology, 2011. / Pharmaceuticals have been formulated to influence physiological systems in humans, animals, and microbes but have never been considered as potential environmental pollutants by healthcare professionals. The human body is not a barrier to chemicals, but is permeable to it. Thus after performing their in-vivo functions, pharmaceutical compound introduced into the body, exit mainly via urine and faeces. Sewage therefore contains highly complex mixtures of chemicals in various degrees of biological potency. Sewage treatment works including those in South Africa, on the other hand, are known to be inefficient in removing drugs from sewage and consequently either the unmetabolised pharmaceutical compounds or their metabolites emerge in the environment as pollutants via several trajectories. In the environment, the excreted metabolites may even undergo regeneration to the original parent molecule under bacterial influence, resulting in “trans-vivo-pharmaceutical-pol ution-cycles”. Although all incinerators are known to generate toxins such dioxins and furans from the drugs they incinerate, all the medicines disposed by the hospitals under research, were incinerated, as the preferred option of disposal. The incineration process employed was found to be environmentally unsafe. Expired and unused medicines which the general public discard as municipal solid waste become landfilled. Because many landfill sites are not appropriately engineered, the unwanted drugs landfilled therein, leach into the surrounding ground water, which is the influent source of water treatment plants. Water treatment plants, including those in South Africa, are also inefficient in eliminating pharmaceutical compounds, releasing them in sub-therapeutic concentrations into potable tap water as pollutants, the full effects of which are yet to be determined.