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

Published Article / The objective of the study was to assess the medical waste management practices used by clinics located in the Polokwane Municipality, South Africa. The clinic personnel were not informed prior to the visit. A walkthrough survey was conducted on-site where potential health and safety risks were identified and noted. The health care personnel in charge of specific clinics completed the questionnaires providing general and detailed information about the treatment and disposal of medical waste. Frequencies and percentages were calculated from the data obtained. Data obtained indicate that (i) medical waste was not segregated from general waste in most of the clinics, (ii) rural clinics were burning medical waste with general waste inside the clinic yard (iii) there was no sufficient collection and transport of medical waste in clinics, (iv) sharps were disposed at various hospital incinerators and (v) most of the clinics did not have storage facilities for medical waste.

Due to the limited studies related to healthcare services future expanding demand, required resources and utilities, and related environmental and economic challenges; this research is carried out to complement other researchers in other economic sectors to identify the gaps, highlight good potentials of sustainability achievements and recommend necessary actions. This research investigates the future expanding demand of healthcare services; the environmental and economic challenges related to this expand and its environmental and economic impacts and the opportunities to overcome these impacts in order to improve healthcare services sustainability and performance. The research follows a SLR to discover earlier works related to environmental sustainability in buildings and healthcare facilities. The environmental challenges related to expanding in healthcare facilities found in the literature are increase in energy consumption and waste generation. The environmental impacts related to these challenges are excessive CO2 and GHG emissions. The economic impacts are escalations of project expenditures, operating expenditures and utilities expenditures. The research uses SD Analysis, as a methodological approach, to framework and understands different healthcare system elements and to develop models that are representing the dynamic relations between these elements. Bahrain healthcare system is selected as a research context due to the availability of good quality healthcare secondary data, the small size of the country that makes it a good model to implement and test new concepts, the limited country resources, and the country keenness to implement sustainability plans to meet sustainability objectives. This research numerically tests and subsequently, supports the implication of stated environmental and economic challenges. It also develops a number of important technical parameters and indicators such as energy and water benchmarks for different healthcare facilities. The research also determines another two sources of environmental challenges related to expanding in healthcare facilities. The first challenge is excessive water consumption. Availability of enough treated water for healthcare applications, especially in countries with limited fresh water resources and depending on 90% of its water need on desalination like Bahrain, a tangible environmental challenge needs to be addressed. The second one is a group of environmental challenges related to the practicing of healthcare services that can expose personnel and environment to high risks. These challenges need to be efficiently managed to improve the environmental sustainability and the social sustainability of healthcare facilities. The research also investigates the effectiveness of a number of mitigation measures used to overcome the environmental and economic negative impacts, such as using energy efficiency technologies, renewable-based energy resources and waste energy recovery. In this regard, the research numerically tests and subsequently supports the implication of stated environmental and economic impacts and the effectiveness of tested measures in mitigating the undesirable results on healthcare facilities. The developed SD Model, as one of the main contributions of this research, is considered as a strategic planning and decision-making administrative tools to forecast future healthcare facilities demand and required resources. It is also considered as a risk assessment tool to assess environmental challenges related to utilities and its environmental and economic impacts in order to improve healthcare facilities sustainability and performance. The potential of utilities saving and utilities expenditures saving in healthcare buildings are high and it is recommended to work toward energy efficiency and renewable energy deployment to achieve sustainable healthcare buildings. Recovery of energy from Medical Waste incineration to be kept under consideration as it is offsetting double the quantity of CO2e emissions resulting from the incineration process. Safe recycling of wastewater of some healthcare processes is highly recommended as it can reduce water consumption and contributes to the reduction of healthcare facilities CO2e emissions. Sources of gray water and gray water applications must be carefully selected to avoid any contradiction with Infection Control regulations or other healthcare regulations. It is recommended to conduct utilities assessment studies on wide sample of healthcare facilities to avoid low peaks and odd operation periods.

POPs are a group of chemicals that have been extensively studied over the last few years. The main reason that these chemicals have received so much scientific attention is the myriad of negative effects they have on the environment and human health. The properties that cause the deleterious effects include a high molecular stability, rendering them highly persistent. Added to this is the lipophilic and hydrophobic nature of the compounds. POPs will thus tend to bio-accumulate and bio-magnify in the environment, causing a direct threat to humans and wildlife. To address this threat, the Stockholm Convention on Persistent Organic Pollutants, under the supervision of United Nations Environment programme (UNEP), was initiated and became legally binding on 17 May 2004. All countries, including South Africa, which ratified this agreement, will be expected to monitor and regulate the formation of POPs. Polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) are all members of the dioxin-like family of POPs. This family of chemicals pose serious health threats such as carcinogenic effects and negative effects on reproduction. These substances, with the exception of PCBs, are formed unintentionally as by-products of industrial and thermal processes. One of the main sources of dioxin-like chemicals is medical waste incinerators. In this project the area surrounding a medical waste incinerator was monitored using a bio-assay technique. The determination of dioxin concentrations is usually preformed by chemical analysis, however, bio-assays have proven themselves to be a cheaper and time-saving screening method. The Toxic Equivalency Quotient (TEQs) determined through bio-assays can support chemical analysis in determining biologically-relevant risk assessments since bio-assay data has ecotoxicological relevance. These assays represent an integrated biological response to chemical pollutants, where biological effects are accounted for which is not possible in chemical analyses. One of the bio-assays used in the determination of the dioxin-like chemical TEQ is the H411 E reporter gene bio-assay. This assay is based on the Ah-receptor mediated toxicity of dioxin-like chemicals. Using this technique the TEQs for areas surrounding an active incinerator were determined, to indicate the distribution of these substances. The TEQs for the soil samples collected ranged between nondetectable and 154 ngTEQ/kg. There was no clear distributional pattern and the total organic carbon content in the soil did not seem to play a crucial role in the distribution of dioxin-like chemicals. Although a decrease in soil tillage showed a corresponding increase in TEQ. The predominant wind direction was taken into account but no correlation could be seen. However, meteorological parameters such as the ambient temperature and low precipitation in the area may have contributed to lower TEQ values. Cytotoxicity excluded data points and the phenomenon has to be addressed. High TEQ values in a residential area where free-range chickens are raised pose a serious concern to the level of dietary dioxin-like chemical intake. Eggs in the area could theoretically contain between 2.75 and 28.75 pgTEQ/g egg fat. Further studies are needed to determine how much dioxin-like chemicals are being transferred to humans through the consumption of free-range eggs / Thesis (M. Environmental Science)--North-West University, Potchefstroom Campus, 2006.

POPs are a group of chemicals that have been extensively studied over the last few years. The main reason that these chemicals have received so much scientific attention is the myriad of negative effects they have on the environment and human health. The properties that cause the deleterious effects include a high molecular stability, rendering them highly persistent. Added to this is the lipophilic and hydrophobic nature of the compounds. POPs will thus tend to bio-accumulate and bio-magnify in the environment, causing a direct threat to humans and wildlife. To address this threat, the Stockholm Convention on Persistent Organic Pollutants, under the supervision of United Nations Environment programme (UNEP), was initiated and became legally binding on 17 May 2004. All countries, including South Africa, which ratified this agreement, will be expected to monitor and regulate the formation of POPs. Polychlorinated dibenzo-p-dioxins (PCDDs), polychlorinated dibenzofurans (PCDFs) and polychlorinated biphenyls (PCBs) are all members of the dioxin-like family of POPs. This family of chemicals pose serious health threats such as carcinogenic effects and negative effects on reproduction. These substances, with the exception of PCBs, are formed unintentionally as by-products of industrial and thermal processes. One of the main sources of dioxin-like chemicals is medical waste incinerators. In this project the area surrounding a medical waste incinerator was monitored using a bio-assay technique. The determination of dioxin concentrations is usually preformed by chemical analysis, however, bio-assays have proven themselves to be a cheaper and time-saving screening method. The Toxic Equivalency Quotient (TEQs) determined through bio-assays can support chemical analysis in determining biologically-relevant risk assessments since bio-assay data has ecotoxicological relevance. These assays represent an integrated biological response to chemical pollutants, where biological effects are accounted for which is not possible in chemical analyses. One of the bio-assays used in the determination of the dioxin-like chemical TEQ is the H411 E reporter gene bio-assay. This assay is based on the Ah-receptor mediated toxicity of dioxin-like chemicals. Using this technique the TEQs for areas surrounding an active incinerator were determined, to indicate the distribution of these substances. The TEQs for the soil samples collected ranged between nondetectable and 154 ngTEQ/kg. There was no clear distributional pattern and the total organic carbon content in the soil did not seem to play a crucial role in the distribution of dioxin-like chemicals. Although a decrease in soil tillage showed a corresponding increase in TEQ. The predominant wind direction was taken into account but no correlation could be seen. However, meteorological parameters such as the ambient temperature and low precipitation in the area may have contributed to lower TEQ values. Cytotoxicity excluded data points and the phenomenon has to be addressed. High TEQ values in a residential area where free-range chickens are raised pose a serious concern to the level of dietary dioxin-like chemical intake. Eggs in the area could theoretically contain between 2.75 and 28.75 pgTEQ/g egg fat. Further studies are needed to determine how much dioxin-like chemicals are being transferred to humans through the consumption of free-range eggs / Thesis (M. Environmental Science)--North-West University, Potchefstroom Campus, 2006.

Thesis (Ph. D.)--University of Illinois at Chicago, 1999. / eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references.

Thesis (Ph. D.)--University of Illinois at Chicago, 1999. / Includes bibliographical references.

A Política Nacional de Resíduos Sólidos (PNRS) entrou em vigor no Brasil em agosto de 2010. Devido à sua recente implantação, muitas organizações ainda estão se adaptando às novas visões que esta lei propõe sobre a gestão dos resíduos no país. A cadeia de suprimentos de materiais médico-hospitalares também faz parte dessa gama de organizações em adaptação, onde novos desafios a respeito da gestão dos resíduos têm surgido. Devido ao tipo de resíduo gerado nas atividades de saúde, o assunto ganha importância e merece atenção especial por parte dos agentes dessa cadeia de suprimentos. Boa parte dos resíduos gerados em atividades de saúde é considerada resíduo perigoso, por esse motivo, os objetivos da PNRS, como a redução do volume e da periculosidade desses resíduos, podem exercer pressões sobre os agentes envolvidos na fabricação, consumo e descarte dos mesmos. Assim, este trabalho teve por objetivo identificar como ocorre a gestão da cadeia de suprimentos de materiais médico-hospitalares no estado do Rio Grande do Sul sob o enfoque da PNRS. Para isso, foram abordados agentes de três níveis dessa cadeia: 1- fornecedores de materiais médico-hospitalares, 2- hospitais e 3- empresas de tratamento de resíduos de saúde. Com a finalidade de enriquecer a visão dessa cadeia, abordaram-se também alguns órgãos governamentais relacionados às questões de resíduos. Buscou-se identificar na cadeia, a existência ou não de colaboração entre os agentes, dificuldades e oportunidades na gestão de resíduos e produtos e processos relacionados às questões de resíduos. O método utilizado foi o estudo de caso e a coleta de dados se deu por meio de entrevistas com gestores de diferentes agentes da cadeia de suprimentos de materiais médico-hospitalares no estado do Rio Grande do Sul. Foram abordadas 11 instituições pertencentes à cadeia mencionada, das quais foram entrevistados 17 profissionais. Foi possível identificar a ausência de colaboração com os fornecedores da cadeia, e a colaboração incipiente entre os demais membros. Também foi possível identificar dificuldades como o aumento da descartabilidade dos produtos, a má segregação e a falta de tratamento adequado aos produtos químicos. As oportunidades foram apresentadas como possibilidade de intervenção do governo sobre as questões na forma de estímulo ao desenvolvimento de produtos menos agressivos e aumento das pressões legais sobre os agentes. Entre os produtos e processos destacaram-se os produtos que contenham matérias-primas menos agressivas na destinação final, a logística reversa e a substituição do consumo de produtos por serviços. / The Brazilian National Policy on Solid Waste (NPSW) entered into force in August 2010. Due to its recent implementation, many organizations are still adjusting to new visions that this law proposes in terms of waste management in the country. The supply chain of medical and hospital supplies is also part of this group of organizations that are currently in adaptation, and where new challenges regarding waste management have emerged. Due to the type of waste generated in health activities, this issue becomes important and deserves special attention from the agents of this supply chain. Much of the waste generated in health activities is considered a hazardous waste, and for that reason, the objectives of NPSW, such as reducing the volume and hazard of the waste, can put pressure on those involved in the production, consumption and disposal of this kind of waste. This study therefore aimed to identify the management of the medical and hospital supply chain in the state of Rio Grande do Sul, under the approach of NPSW. To achieve the objectives, different agents were approached, representing the three levels of the chain: 1 - suppliers of medical and hospital material, 2 - hospitals and 3 - companies specialized in the treatment of health waste. In order to enrich the results, governmental bodies were also addressed on their views towards health waste issues. Overall, the aim was to identify the existence or absence of collaboration between agents, the difficulties and opportunities in waste management and finally, the products and processes related to waste issues within this supply chain. The case study method was used and data was collected through interviews with managers of different agents in the supply chain of medical and hospital supplies in the state of Rio Grande do Sul. In total, 17 professionals from 11 health-related institutions were interviewed. As main results, it was possible to identify the absence of cooperation with the suppliers of the chain, and incipient collaboration between the remaining members. It was also possible to identify difficulties, as the increasing disposability of products, poor segregation and lack of adequate treatment for chemical products. The opportunities were presented as a possibility for governmental intervention - that could act as stimulus for the development of less aggressive products and increase the legal pressure on chain agents to comply with the legislation. Among the products and processes investigated, interviewees highlighted products containing raw materials that are less aggressive in their final disposal, reverse logistics and replacement of consumer products for services.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-02T18:58:31Z No. of bitstreams: 1 DISS MP PAULA CRISTINA RIBEIRO 2013.pdf: 861102 bytes, checksum: ccbee8bd23b49b48a2d9d26baae83d1e (MD5) / Approved for entry into archive by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2014-10-02T19:00:03Z (GMT) No. of bitstreams: 1 DISS MP PAULA CRISTINA RIBEIRO 2013.pdf: 861102 bytes, checksum: ccbee8bd23b49b48a2d9d26baae83d1e (MD5) / Made available in DSpace on 2014-10-02T19:00:03Z (GMT). No. of bitstreams: 1 DISS MP PAULA CRISTINA RIBEIRO 2013.pdf: 861102 bytes, checksum: ccbee8bd23b49b48a2d9d26baae83d1e (MD5) / Resíduos de Serviços de Saúde (RSS) são aqueles resultantes de atividades desenvolvidas nos estabelecimentos de saúde, sendo classificados como resíduos perigosos em função de suas propriedades físicas, químicas ou infectocontagiosas, pois podem apresentar riscos à saúde pública e ao meio ambiente, quando gerenciados de forma inadequada. Os serviços de saúde são responsáveis pelo gerenciamento de todos os resíduos por eles gerados e por elaborar o Plano de Gerenciamento de Resíduos de Serviços de Saúde (PGRSS). Compete à Vigilância Sanitária (VISA) orientar e fiscalizar o gerenciamento desses resíduos de acordo com a legislação vigente, bem como analisar o PGRSS. Este estudo objetivou analisar as ações da Vigilância Sanitária do Estado da Bahia (VISA-BA) no controle sanitário dos RSS em hospitais de gestão estadual localizados em Salvador e Região Metropolitana. Para tanto, foi realizado um estudo de caso único na VISABA, com abordagem qualiquantitativa, utilizando como estratégias para coleta de dados, a análise dos prontuários dos hospitais arquivados na VISA-BA e entrevistas com técnicos que atuam no controle sanitário dos hospitais. Os resultados apontaram grande oscilação no número de PGRSS analisados entre os anos de 2007 a 2012. Dos 18 hospitais, 16 (89%) possuem PGRSS. Foram realizadas 22 inspeções nestes hospitais nos anos de 2005 a 2011, sendo que em 07 (39%) dos 18 hospitais não havia registro de inspeção neste período. Os relatórios de inspeção e notificações relacionados às inspeções demonstraram que em 18 das 22 inspeções houve registros de não conformidades relacionadas à RSS. Dentre estas, a maior prevalência foi “presença de lixeiras sem tampa e sem pedal”, seguida por “abrigo externo de RSS com problemas”. As entrevistas com os técnicos revelaram: ausência de inspeção para verificar se o que está descrito no PGRSS encaminhado à VISA-BA para análise, é o que está em prática no estabelecimento; número reduzido de técnicos para analisar os PGRSS e falta de articulação entre técnicos que realizam esta atividade e técnicos que fazem inspeção nos serviços de saúde. Mostrou-se necessário aprimorar as ações de orientação aos serviços de saúde sobre RSS, pois há um alto índice de indeferimento dos PGRSS. Da mesma forma, aprimorar a abordagem de RSS nos roteiros de inspeção utilizados e realizar atualizações sobre o tema para os técnicos da VISA-BA, sendo também fundamental o fortalecimento da articulação inter e intrasetorial.

A Política Nacional de Resíduos Sólidos (PNRS) entrou em vigor no Brasil em agosto de 2010. Devido à sua recente implantação, muitas organizações ainda estão se adaptando às novas visões que esta lei propõe sobre a gestão dos resíduos no país. A cadeia de suprimentos de materiais médico-hospitalares também faz parte dessa gama de organizações em adaptação, onde novos desafios a respeito da gestão dos resíduos têm surgido. Devido ao tipo de resíduo gerado nas atividades de saúde, o assunto ganha importância e merece atenção especial por parte dos agentes dessa cadeia de suprimentos. Boa parte dos resíduos gerados em atividades de saúde é considerada resíduo perigoso, por esse motivo, os objetivos da PNRS, como a redução do volume e da periculosidade desses resíduos, podem exercer pressões sobre os agentes envolvidos na fabricação, consumo e descarte dos mesmos. Assim, este trabalho teve por objetivo identificar como ocorre a gestão da cadeia de suprimentos de materiais médico-hospitalares no estado do Rio Grande do Sul sob o enfoque da PNRS. Para isso, foram abordados agentes de três níveis dessa cadeia: 1- fornecedores de materiais médico-hospitalares, 2- hospitais e 3- empresas de tratamento de resíduos de saúde. Com a finalidade de enriquecer a visão dessa cadeia, abordaram-se também alguns órgãos governamentais relacionados às questões de resíduos. Buscou-se identificar na cadeia, a existência ou não de colaboração entre os agentes, dificuldades e oportunidades na gestão de resíduos e produtos e processos relacionados às questões de resíduos. O método utilizado foi o estudo de caso e a coleta de dados se deu por meio de entrevistas com gestores de diferentes agentes da cadeia de suprimentos de materiais médico-hospitalares no estado do Rio Grande do Sul. Foram abordadas 11 instituições pertencentes à cadeia mencionada, das quais foram entrevistados 17 profissionais. Foi possível identificar a ausência de colaboração com os fornecedores da cadeia, e a colaboração incipiente entre os demais membros. Também foi possível identificar dificuldades como o aumento da descartabilidade dos produtos, a má segregação e a falta de tratamento adequado aos produtos químicos. As oportunidades foram apresentadas como possibilidade de intervenção do governo sobre as questões na forma de estímulo ao desenvolvimento de produtos menos agressivos e aumento das pressões legais sobre os agentes. Entre os produtos e processos destacaram-se os produtos que contenham matérias-primas menos agressivas na destinação final, a logística reversa e a substituição do consumo de produtos por serviços. / The Brazilian National Policy on Solid Waste (NPSW) entered into force in August 2010. Due to its recent implementation, many organizations are still adjusting to new visions that this law proposes in terms of waste management in the country. The supply chain of medical and hospital supplies is also part of this group of organizations that are currently in adaptation, and where new challenges regarding waste management have emerged. Due to the type of waste generated in health activities, this issue becomes important and deserves special attention from the agents of this supply chain. Much of the waste generated in health activities is considered a hazardous waste, and for that reason, the objectives of NPSW, such as reducing the volume and hazard of the waste, can put pressure on those involved in the production, consumption and disposal of this kind of waste. This study therefore aimed to identify the management of the medical and hospital supply chain in the state of Rio Grande do Sul, under the approach of NPSW. To achieve the objectives, different agents were approached, representing the three levels of the chain: 1 - suppliers of medical and hospital material, 2 - hospitals and 3 - companies specialized in the treatment of health waste. In order to enrich the results, governmental bodies were also addressed on their views towards health waste issues. Overall, the aim was to identify the existence or absence of collaboration between agents, the difficulties and opportunities in waste management and finally, the products and processes related to waste issues within this supply chain. The case study method was used and data was collected through interviews with managers of different agents in the supply chain of medical and hospital supplies in the state of Rio Grande do Sul. In total, 17 professionals from 11 health-related institutions were interviewed. As main results, it was possible to identify the absence of cooperation with the suppliers of the chain, and incipient collaboration between the remaining members. It was also possible to identify difficulties, as the increasing disposability of products, poor segregation and lack of adequate treatment for chemical products. The opportunities were presented as a possibility for governmental intervention - that could act as stimulus for the development of less aggressive products and increase the legal pressure on chain agents to comply with the legislation. Among the products and processes investigated, interviewees highlighted products containing raw materials that are less aggressive in their final disposal, reverse logistics and replacement of consumer products for services.