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.

The present study sought to establish relationships that exist between the management of solid waste with infectious cases of Infections Related to Health Care (IRHC) in the Adult Intensive Care Unit (ICU-A) of the Emergency Hospital of Sergipe (EHSE), this study aimed to assess the relationship between generators disease vectors found in the referenced industry and infectious waste generated in this health unit. Therefore, it is necessary to: determine how is the handling of infectious solid waste in the ICU-A of a EHSE sector ; identify how the management of infectious waste enables the development of vectors for IRHC , and finally check the preparation of professionals to manage these wastes . Should point out that this is an exploratory research and the field of knowledge was exploited by the inductive method. The literature and empirical basis, about the information necessary for the interpretation and analysis of data is delineated by access to the records of the Committee on Hospital Infection Control (CHIC), which contains the indices of nosocomial infection from 2008 to 2011 and the rules techniques and resolutions codified in chips summaries. Contacts with professionals working in ICU-A and CHIC, support staff and coordination respectively, were also established standardized interviews were conducted, which follow a prescribed script, see Appendix D. The instruments for data collection were used unstructured observation, the field notebook and camera for the purpose of use of the uses of expressions, fragments and images about the current functioning of infectious solid waste management, which are developed based on content analysis. As for the results it was found that among the types of waste generated in the ICU-A EHSE, the sharps are the ones that can be associated with the spread of infectious diseases, these arising from accidents at the time of its disposal, and its occurrence in mostly with housekeeping staff who deal with this type of waste that is commonly and improperly arranged by the clinic staff. However, it became clear that a correct and efficient management of such wastes may prevent scratches and damage in transforming health promotion, and the development of practices for the principles of reverse logistics. / O presente estudo procurou estabelecer que relações existem entre o gerenciamento de resíduos sólidos infectantes com os casos de Infecções Relacionadas à Assistência à Saúde (IRAS) na Unidade de Terapia Intensiva Adulta (UTI-A) do Hospital de Urgência de Sergipe (HUSE), este estudo teve como propósito avaliar a relação entre vetores geradores de doenças encontrados no setor referenciado e os resíduos infectantes gerados nesta unidade de saúde. Para tanto, faz-se necessário: averiguar como é feito o manejo de resíduos sólidos infectantes no setor da UTI-A do HUSE; identificar de que forma o manejo de resíduos infectantes propicia o desenvolvimento de vetores para IRAS; e por fim verificar o preparo dos profissionais para o manejo desses resíduos. Convém pontuar que se trata de uma pesquisa de caráter exploratório e o campo de conhecimento foi explorado pelo método indutivo. A pesquisa bibliográfica e de base empírica, acerca das informações necessárias para interpretação e análise dos dados se delineou mediante o acesso aos registros da Comissão de Controle de Infecção Hospitalar (CCIH), na qual constam os índices de infecção hospitalar de 2008 a 2011 e a normas técnicas e resoluções sistematizadas em fichas resumos. Também foram estabelecidos contatos com os profissionais que trabalham na UTI-A e na CCIH, pessoal de apoio e coordenação respectivamente, foram realizadas entrevistas padronizadas, as quais seguem um roteiro previamente estabelecido, ver apêndice D. Como instrumentos para a coleta de dados foram utilizados a observação não estruturada, o caderno de campo e a máquina fotográfica para efeito de utilização dos usos de expressões, fragmentos e imagens sobre o atual funcionamento da gestão de resíduos sólidos infectantes, sendo estas desenvolvidas com base na análise de conteúdo. Quanto aos resultados foi constatado que dentre os tipos de resíduos gerados na UTI-A do HUSE, os perfurocortantes são os únicos que podem estar associados à propagação de doenças infecciosas, estas, decorrentes de acidentes no momento de sua disposição, sendo sua ocorrência em maior parte com funcionários da limpeza que lidam com este tipo de resíduo e que é comumente disposto inadequadamente pela equipe clínica. No entanto, evidenciou-se que um gerenciamento correto e eficiente desses resíduos pode prevenir riscos e transformar dano em promoção da saúde, como o desenvolvimento de práticas voltadas para os princípios da logística reversa.

The object of this research was to analyze the waste management of health services in hospitals located in the city of Aracaju/SE. Specifically, sought to describe the procedures for segregation, packaging, collection, storage, transportation, treatment and final disposal of the solid waste management, analyze the degree of officials knowledge of the hospitals on the management of such wastes and perform comparative analysis of management practices in hospitals RSS, verifying their compliance with Resolution No. 306/2004 of ANVISA. This is a descriptive and exploratory study, whose research strategy adopted was multiple case study. Data collection was conducted through semi-structured questionnaire application, on-site observation, with the help of script and document analysis. The research population consisted of 285 professionals from the clinical staff (doctors, nurses, technicians and nursing assistants) and hygienist of the three hospitals studied, defined by non-probability sampling by quotas. Data were analyzed with SPSS software, content analysis and triangulation of data. It was found that all healthcare facilities searched showed problems related to inadequate segregation of waste. The three hospitals surveyed have the same procedures with respect to segregation, packing, collection, storage, transportation, treatment and final disposal of the solid waste management. In two establishments, the locations used for external storage of waste do not meet current standards. Private hospitals had the solid waste management plan duly updated and structured and seek to meet current standards and their applicability correct. It was noted, however, that the respondents, in all hospitals, have low level of knowledge about issues related to the management of solid waste management held by health facilities. In general, it was found that establishments assessed implement a policy requiring training, using attractive and efficient mechanisms for training of professionals involved in the management of solid waste management. / O objeto central desta pesquisa é analisar a gestão dos resíduos sólidos de serviços de saúde (RSS) em unidades hospitalares localizadas na cidade de Aracaju/SE. Especificamente, busca: descrever os procedimentos de segregação, acondicionamento, coleta, armazenamento, transporte, tratamento e disposição final dos RSS; analisar o grau de conhecimento dos funcionários das unidades hospitalares sobre a gestão desses resíduos e efetuar análise comparativa das práticas de gestão dos RSS nas unidades hospitalares pesquisadas. Trata-se de uma pesquisa descritivo-exploratória, cuja estratégia de pesquisa adotada foi estudo de casos múltiplos. A coleta de dados foi realizada através de aplicação de questionário semiestruturado, observação in loco, com auxílio de roteiro e com análise de documentos. A população pesquisada é formada por 285 profissionais pertencentes à equipe clínica (médicos, enfermeiros, técnicos e auxiliares de enfermagem) e higienizadores dos três hospitais analisados, definidos através da técnica de amostragem não probabilística por cotas. As técnicas utilizadas para a análise dos dados foram o software SPSS, a análise de conteúdo e a triangulação dos dados. Verificou-se que todas as unidades de saúde pesquisadas apresentaram problemas com relação à segregação inadequada dos resíduos. Os três hospitais pesquisados apresentam os mesmos procedimentos com relação à segregação, acondicionamento, coleta, armazenamento, transporte, tratamento e disposição final dos RSS. Em dois estabelecimentos, os locais utilizados para o armazenamento externo dos resíduos não atendem às normas vigentes. Os hospitais privados apresentaram o PGRSS devidamente atualizado e estruturado e procuram atender às normas vigentes e sua correta aplicabilidade. Constatou-se, entretanto, que os profissionais entrevistados, em todos os hospitais, possuem reduzido grau de conhecimento sobre as questões relacionadas à gestão dos RSS realizada pelas unidades de saúde. De um modo geral, verificou-se que os estabelecimentos avaliados necessitam implantar uma política de capacitação, com utilização de mecanismos atrativos e eficientes para o treinamento dos profissionais envolvidos no manejo dos RSS.

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.

Healthcare waste management is very important due to its hazardous nature that can cause risk to human health and the environment. The study wished to determine the amount of healthcare waste generated in 15 public health centres and 3 hospitals and evaluate the healthcare waste management practices in Addis Ababa City Administration. The aim of the study was to develop a manual for healthcare facilities based on the findings on healthcare waste management practice, quantification and intervention. Data was obtained from questionnaires distributed to 636 randomly selected healthcare professionals, ancillary staff and managers and by means of surveying the facilities. The mean HCW generation rate was 10.64 + 5.79 kg/day, of which 37.26% (3.96 + 2.017kg/day) was general waste and 62.74% (6.68 + 4.293 kg/day) was hazardous waste from the surveyed health centres. HCW generation and quantification was not measured and documented in any of the HCFs. Quantifying HCW would help determine the type of waste as well as the HCFs that generate the highest and lowest HCW, which could have implications for resource allocation in managing HCW. Segregation of different types of wastes was not regularly done. Some HCFs had separate storage areas for HCW and separate containers for hazardous and nonhazardous waste. In some instances, however, the containers were not clearly marked. Regarding storage, some of the HCFs had interim storage sites and HCW disposal sites. Several interim storage facilities lacked security and surveillance and were not cleaned after collection. In addition, HCW remained at the interim storage facilities for more than 48 hours before final disposal. The main forms of on-site treatment of HCW before disposal were burning, crushing sharps, sterilisation and chemical disinfection. The most common treatment method used for HCW was incineration. Most HCW handlers had not received adequate training; did not wear PPE, and did not take precautionary measures, such as washing their hands and heavy duty gloves after handling HCW. The researcher developed a manual for effective HCW management and training of HCW handlers. Based on the findings, the study makes recommendations for policy, education, HCW management, including generation, segregation, storage, transportation and disposal, and further research. / Health Studies / D. Litt. et Phil. (Health Studies)

The South African Waste Information System (SAWIS) was developed by the Department of Environmental Affairs and Tourism (DEAT) in 2005. This is a system used by government and industry to capture routine data on the tonnages of waste generated, recycled and disposed of in South Africa on a monthly and annual basis. All waste producers and waste management organisations should contribute to this national waste database and should accurately monitor the types and quantities of waste produced and handled. According to DEAT (2006) the need for Data verification is important. DEAT (2006:59) defined the term Data Verification as: "assessing data accuracy, completeness, consistency, availability and internal control practices that serve to determine the overall reliability of the data collected." The aim of the study is to determine a procedure, as well as the nature and extent of internal and external source documents, which could be used in the reconciliation of medical waste quantities from generation to disposal. The key objectives are to determine whether the selected hospitals keep internal records of the quantities of medical waste generated; to reconcile the waste quantities on the internal records with the external records, such as the collection certificates, invoices and waste incineration certificates; to ascertain whether the quantity of medical waste generated is equal to the quantity of waste incinerated and disposed of to determine the ratio factor between the quantity of medical waste before incineration and the quantity of the residue (ashes) after incineration, and to make recommendations on the reconciliation of waste quantities from the point of generation to the point of disposal. The results of the study indicate that the destruction certificate is the proof that the waste that was on-site collected by the service provider has been disposed /treated. Especially as an internal control measure. The health care risk waste (HCRW) management record keeping of quantities of weight as per Hospital A, Hospital B and Hospital C allows the opportunity to analyse the weight per month and per Hospital and per category and to make comparisons. The weakness or the gap however still exist that the waste is not weighed at the point of origin, but at the point where the waste service provider collects the waste onsite. It is from this point onwards that the service level agreement between the hospital and the waste service provider and the document management system and the tracking receipt and the waste collection documents (WCD) becomes relevant and where the quantities of waste per category are for the first time recorded. The hypothesis as stated in Chapter 1 was proven valid. The study concludes that reconciliation and comparison between the collection certificate and the destruction certificate and the monthly invoice is therefore possible, but the risk of mixing of waste and the understating or overstating of waste quantities is still not overcome. / Environmental Sciences / M. Sc. (Environmental management)

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.

MPH / Department of Public Health / See the attached abstract below

PhD (Public Health) / Department of Public Health / Medical waste is a special type of hazardous waste generated from healthcare facilities. Mismanagement of this waste has a negative impact on healthcare workers, patients and their relatives, medical waste handlers and the community. South Africa, like many other developing countries, is resource-constrained in the management of medical waste and poor practices have been reported across the country, especially in the urban health facilities that have received more attention from researchers. This study was conducted to explore the practices and challenges of medical waste management in Vhembe District, a largely rural district in Limpopo province and develop intervention strategies for better management of the waste in the District. A convergent parallel approach of mixed method design was adopted to achieve the objectives of this study. The target population included the main stakeholders of medical waste management in the district: the Department of Health, healthcare facilities and the waste management company responsible for the treatment and disposal of medical waste in Limpopo Province. The study population from the Department of Health included representatives from the medical waste management section while the waste management company was represented by the manager of the company in Limpopo Province. The samples for the healthcare facilities were drawn from fifteen randomly selected healthcare facilities in the district and included the administrative heads, medical waste generators and medical waste handlers. The study was conducted in three phases. Phase 1 was a qualitative study during which the administrative heads of the selected healthcare facilities, personnel directly involved in medical waste management at the healthcare facilities as well as the representatives from the Department of Health and waste management company were engaged in in-depth interviews. This phase also involved voice recording, observations, field documentation and taking of relevant pictures. Thematic content analysis was used to analyze the data obtained. During phase 2 (quantitative study), a semi-structured questionnaire was employed for data collection from medical waste generators and handlers at the healthcare facilities. A total of 229 questionnaires were retrieved from the participants and were analyzed with the Statistical Package for Social Sciences version 25.0. Descriptive statistical analyses were performed; Chi-square and Cramer’s V tests were used to determine the associations between dependent and independent variables, as well as the strength of association where significant relationships exist. Statistical significant level was set at p<0.05 and the results are presented in tables and graphs. The results from both phases were interpreted and discussed simultaneously. Respondents and participants were assured of anonymity of their identities and confidentiality of the information they provided. They were given adequate information about the study and only those who volunteered participated in the study after appending their signatures on the informed consent form. In phase 3, the Medical Research Council Framework was used to develop intervention strategies for improved medical waste management in Vhembe District based on the Strength, Weakness, Opportunity and Threat (SWOT) and Political, Economic, Social, Technological, Environmental and Legal (PESTEL) analysis techniques. The study revealed inefficient practices of medical waste management in all the healthcare facilities. Rate of medical waste generation was 338.15kg/day, 19.2kg/day and 15.5kg/day of HCRW from the hospitals, community health centers and clinics respectively. Segregation practices were poor, and only 28.4% of respondents rated their healthcare institutions as being excellent with medical waste segregation. The type of occupation was found to be significantly associated with exposure to training (p=0.000) and the level of knowledge about medical waste management (p=0.000). Also, the use of personal protective equipment was found to be significantly associated with training (p=0.011). Transportation and temporary storage were not done according to the recommendation in the guidelines and incineration was the main means of treatment of the waste. The final product of waste treatment is being disposed into an hazardous waste landfill. The challenges encountered in the process of managing medical waste include lack of adequate funding and budget for medical waste management, ineffective and irregular training of healthcare workers, non-compliance to medical waste management guidelines, insufficient bins, substandard central storage rooms, insufficient personal protective equipment and unavailability of Hepatitis B vaccine. The strength, weakness, opportunities and threats of medical waste management in Vhembe District were analyzed and specific intervention strategies were developed to improve on the strength, minimize the weakness, take advantage of the opportunity and combat the threats. The developed strategies were validated. This study provides the evidences of poor management of medical waste in Vhembe District, and shows the need for urgent intervention measures to be put in place. We therefore recommend that the intervention strategies proposed here be evaluated and implemented to mitigate the untoward effects of poor medical waste management among healthcare workers and the community as a whole. / NRF