MPH (Occupational Hygiene), Faculty of Health Sciences, University of the Witwatersrand, 2009 / The study of medical waste management practices in Ekurhuleni Metropolitan Municipality clinics in South Africa took place in the absence of the relevant parliamentary law governing such waste, but governed by the final published Gauteng Health Care Waste Management Regulations 3003 of 2003. In accordance with the Gauteng Health Care Waste Management Regulations 303 of 2003, Medical Waste Management Practices are such that where medical waste is generated, it should be segregated at the point of generation, be properly containerised, labelled, stored, treated and finally be disposed of. The researcher studied 29 out of 112 clinics in Ekurhuleni Metropolitan Municipality on whether medical waste management practices in these clinics comply with the Gauteng Health Care Waste Management Regulations 3003 of 2003. The study also intended to help practising and managing nurses to reduce occupational health risks, while further increasing the safety of clinic service users from unforeseen infections by communicable diseases. Materials and methods The study followed a cross-sectional descriptive survey method wherein data acquisition was by means of interviewing clinic managers with regard to medical waste management iii practices in their clinics using a structured questionnaire; and by observations of medical waste management practices through a walkthrough survey checklist. The study sample composed of 30 clinics selected from a total of 112 clinics, where a total population of 7 maternity and 23 day clinics were included through random selection. A response rate of 29 out of 30 clinics selected was obtained. The interview questionnaire consisted of six dimensions of measurement of medical waste management practices, while the walkthrough survey checklist consisted of twenty six items measuring medical waste management practices. Both were developed in line with the stipulations of the Gauteng Health Care Waste Management Regulations 3003 of 2003. A pilot study was conducted to further refine the contents of the above two measuring tools. The study setting comprised individual sections of each clinic such as primary health care, maternity, HIV/AIDS, mental health, antenatal care, family planning and the communicable diseases section, wherein a nurse is assigned per shift to examine patients and to administer injections and medicines. Observations were done on all medical waste management practices in the examination rooms of all sections of the clinics in order to carefully record both negative and positive practices. Such observations made followed the required medical waste management process as per the Gauteng Health Care Waste Management Regulations 3003 of 2003. iv Results The operations of Ekurhuleni municipal clinics revealed a 67 percent (4 out of 6 required documentation) non-existence of the required documentations, predominantly in the areas of medical waste policy; written safe work procedures; a training programme; and conducting of risk assessments. Specifically, The majority (65.5%) of clinics in Ekurhuleni Metropolitan Municipality have no medical waste management policy. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality have no safe work procedures. The majority (93%) of clinics in Ekurhuleni Metropolitan Municipality have no waste management training programme. The majority (69%) of clinics in Ekurhuleni Metropolitan Municipality do not conduct risk assessment for their operations. Of the 26 medical waste management practices observed, positive medical waste management practices were observed in 46 percent of the observations compared to 50 percent of negative observations, made in operating conditions of clinics. Discussion The findings of the study revealed a high degree of non-compliance of Ekurhuleni Metropolitan Municipality with the Gauteng Health Care Waste Management Regulations v 3003 of 2003 with regard to the required documents and the acceptable observed practices. Conclusions Medical waste management training in Ekurhuleni Metropolitan Municipality does not happen due to both the lack of policy documents and budgetary problems. Health care workers are exposed to both ergonomic and biological hazards due to a lack of proper medical waste storage, storage signage and incorrect handling of medical waste. No medical waste management audits and risk assessments are conducted in Ekurhuleni Metropolitan Municipality clinics. Non accountability over disposal of medical waste may promote illegal dumping of medical waste generated from Ekurhuleni municipal clinics. Recommendations Managers of clinics in Ekurhuleni Metropolitan Municipality need to be informed of the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003. Based on the developed policies, clinic managers need to develop medical waste management training programmes wherein the stipulations of Gauteng Health Care Waste Management Regulations 3003 of 2003 will be incorporated. Designated medical waste management storage facilities to be provided for all Ekurhuleni Metropolitan Municipality clinics. vi Clinic management and appointed medical waste management officers to ensure that medical waste management audits and risk assessments are conducted and that corrective measures are implemented in Ekurhuleni Metropolitan Municipality clinics.

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.

No description available.

Desde há alguns anos vêm se tornado a cada vez mais evidentes, as consequências do crescimento da população mundial, da industrialização, e do consumismo que caracteriza nossa sociedade capitalista. Isto é, o aumento da produção de bens materiais, explorando as fontes de materia prima, e a geração descontrolada de resíduos, o que impacta negativamente o meio ambiente e representa riscos para a saúde humana. No contexto dessa problemática de saúde pública, destaca-se a produção de resíduos de serviços de saúde (RSS). Atualmente, é sabido que os resíduos gerados em estabelecimentos de saúde devem ter um gerenciamento especial e diferenciado, pois mesmo que existam resíduos que não apresentam periculosidade, também há determinadas categorias de resíduos potencialmente perigosos. A exposição humana a esses resíduos, perigosos pela sua composição química ou infectante, pode resultar em lesão ou doença. Diferente da realidade dos países desenvolvidos, no Panamá, o gerenciamento de resíduos sólidos ainda se apresenta como um tema negligenciado e que, portanto, não está de acordo com as recomendações internacionais nem cumpre com a legislação vigente do país. Esta investigação visou conhecer a estrutura do gerenciamento dos RSS gerados no Hospital del Niño do Panamá, República do Panamá, com o objetivo de elaborar uma proposta de Plano de Gerenciamento de RSS para este hospital. Partindo do fato de que o Hospital del Niño (HN) é um hospital pediátrico de grande porte, localizado no Município do Panamá, área onde se concentram os principais recursos técnicos e financeiros do país; a futura aplicação do PGRSS tem potencial de repercutir nos demais municípios e cidades do país. Trata-se de uma pesquisa descritiva, baseando-se na observação de campo e entrevistas aos sujeitos selecionados no HN. Os sujeitos selecionados constituiram-se de 2 informantes-chave, responsáveis pelo gerenciamento dos RSS no HN, nos aspectos operacional e administrativo. A análise dos dados foi feita por meio do material obtido com a aplicação do instrumento I-RAT do Programa das Nações Unidas para o Desenvolvimento (PNUD, 2009), incluindo registro fotográfico, anotações feitas em campo e entrevistas realizadas. Os resultados revelaram uma estrutura de gerenciamento de RSS que precisa e pode ser melhorada, e que o local de estudo não cumpre integralmente com as recomendações e exigências legais do país. Também permitiram adotar um modelo de PGRSS, utilizado no estado de São Paulo (COSTA, 2001) e adaptá-lo à realidade panamenha. A proposta do PGRSS resultante deste trabalho é uma ferramenta para o gerenciamento dos resíduos gerados pelo HN e demais estabelecimentos de saúde no Panamá. Este instrumento pode ser útil no sentido de colaborar para a segurança do trabalho, a saúde pública e a proteção do meio ambiente, contribuindo, assim, para uma melhor qualidade de vida / In recent years, it has become increasingly evident the consequences of world population growth, industrialization, and the excessive consumption that characterize our capitalist society. This is the increased production of material assets by exploring the sources of raw material, and uncontrolled waste generation, which impacts negatively the environment and represents risks to human health. In the context of this public health issue, we highlight the waste from health care services. Currently, it is known that the waste generated in healthcare facilities must have a special and differentiated management, this because, even though there are wastes which do not present hazardous characteristics, there are also certain categories of potentially hazardous waste. Human exposure to these hazardous wastes, because of their chemical or infective composition, may result in injury or illness. Different from the reality of developed countries, in Panama, the solid waste management still is presented as a neglected issue and therefore not in accordance with international recommendations nor complies with the current country legislation. This research aimed to getting to know the structure of medical waste management generated at the Hospital del Niño de Panama, Republic of Panama, with the main goal of developing a Medical Waste Management Plan proposal for this hospital. Based on the fact that the Hospital del Niño (HN) is a large scale pediatric hospital, located in the Panama Municipality area, where the main technical and financial resources of the country are concentrated; the future application of a Healthcare Waste Management Plan, may have the potential to positively influence the other municipalities and cities in the country. It is a descriptive research based on field observations and interviews with subjects chosen from the HN. The selected subjects were constituted by 2 key informers, responsible in the operational and administrative aspects, for managing the medical waste at the Hospital. Data analysis was performed with the collected information by the application of the United Nations Development Programmes instrument, the I-RAT (PNUD, 2009), including the photographic recording, the notes taken in field and the held interviews. The results revealed a medical waste management structure that needs and can be improved, and that the research location does not meet integrally with the recommendations and legal requirements of the country. They also allowed to adopt a Medical Waste Management Plan model, used in the state of São Paulo, BR (COSTA, 2001), and adapting it to the Panamanian reality. The proposed Medical Waste Management Plan resulting from this study is a tool for the management of waste generated by the HN and others health establishments over Panama. This tool can be useful to cooperate with occupational safety, public health and environmental protection, thus contributing to a better life quality

Desde há alguns anos vêm se tornado a cada vez mais evidentes, as consequências do crescimento da população mundial, da industrialização, e do consumismo que caracteriza nossa sociedade capitalista. Isto é, o aumento da produção de bens materiais, explorando as fontes de materia prima, e a geração descontrolada de resíduos, o que impacta negativamente o meio ambiente e representa riscos para a saúde humana. No contexto dessa problemática de saúde pública, destaca-se a produção de resíduos de serviços de saúde (RSS). Atualmente, é sabido que os resíduos gerados em estabelecimentos de saúde devem ter um gerenciamento especial e diferenciado, pois mesmo que existam resíduos que não apresentam periculosidade, também há determinadas categorias de resíduos potencialmente perigosos. A exposição humana a esses resíduos, perigosos pela sua composição química ou infectante, pode resultar em lesão ou doença. Diferente da realidade dos países desenvolvidos, no Panamá, o gerenciamento de resíduos sólidos ainda se apresenta como um tema negligenciado e que, portanto, não está de acordo com as recomendações internacionais nem cumpre com a legislação vigente do país. Esta investigação visou conhecer a estrutura do gerenciamento dos RSS gerados no Hospital del Niño do Panamá, República do Panamá, com o objetivo de elaborar uma proposta de Plano de Gerenciamento de RSS para este hospital. Partindo do fato de que o Hospital del Niño (HN) é um hospital pediátrico de grande porte, localizado no Município do Panamá, área onde se concentram os principais recursos técnicos e financeiros do país; a futura aplicação do PGRSS tem potencial de repercutir nos demais municípios e cidades do país. Trata-se de uma pesquisa descritiva, baseando-se na observação de campo e entrevistas aos sujeitos selecionados no HN. Os sujeitos selecionados constituiram-se de 2 informantes-chave, responsáveis pelo gerenciamento dos RSS no HN, nos aspectos operacional e administrativo. A análise dos dados foi feita por meio do material obtido com a aplicação do instrumento I-RAT do Programa das Nações Unidas para o Desenvolvimento (PNUD, 2009), incluindo registro fotográfico, anotações feitas em campo e entrevistas realizadas. Os resultados revelaram uma estrutura de gerenciamento de RSS que precisa e pode ser melhorada, e que o local de estudo não cumpre integralmente com as recomendações e exigências legais do país. Também permitiram adotar um modelo de PGRSS, utilizado no estado de São Paulo (COSTA, 2001) e adaptá-lo à realidade panamenha. A proposta do PGRSS resultante deste trabalho é uma ferramenta para o gerenciamento dos resíduos gerados pelo HN e demais estabelecimentos de saúde no Panamá. Este instrumento pode ser útil no sentido de colaborar para a segurança do trabalho, a saúde pública e a proteção do meio ambiente, contribuindo, assim, para uma melhor qualidade de vida / In recent years, it has become increasingly evident the consequences of world population growth, industrialization, and the excessive consumption that characterize our capitalist society. This is the increased production of material assets by exploring the sources of raw material, and uncontrolled waste generation, which impacts negatively the environment and represents risks to human health. In the context of this public health issue, we highlight the waste from health care services. Currently, it is known that the waste generated in healthcare facilities must have a special and differentiated management, this because, even though there are wastes which do not present hazardous characteristics, there are also certain categories of potentially hazardous waste. Human exposure to these hazardous wastes, because of their chemical or infective composition, may result in injury or illness. Different from the reality of developed countries, in Panama, the solid waste management still is presented as a neglected issue and therefore not in accordance with international recommendations nor complies with the current country legislation. This research aimed to getting to know the structure of medical waste management generated at the Hospital del Niño de Panama, Republic of Panama, with the main goal of developing a Medical Waste Management Plan proposal for this hospital. Based on the fact that the Hospital del Niño (HN) is a large scale pediatric hospital, located in the Panama Municipality area, where the main technical and financial resources of the country are concentrated; the future application of a Healthcare Waste Management Plan, may have the potential to positively influence the other municipalities and cities in the country. It is a descriptive research based on field observations and interviews with subjects chosen from the HN. The selected subjects were constituted by 2 key informers, responsible in the operational and administrative aspects, for managing the medical waste at the Hospital. Data analysis was performed with the collected information by the application of the United Nations Development Programmes instrument, the I-RAT (PNUD, 2009), including the photographic recording, the notes taken in field and the held interviews. The results revealed a medical waste management structure that needs and can be improved, and that the research location does not meet integrally with the recommendations and legal requirements of the country. They also allowed to adopt a Medical Waste Management Plan model, used in the state of São Paulo, BR (COSTA, 2001), and adapting it to the Panamanian reality. The proposed Medical Waste Management Plan resulting from this study is a tool for the management of waste generated by the HN and others health establishments over Panama. This tool can be useful to cooperate with occupational safety, public health and environmental protection, thus contributing to a better life quality

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