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The management of healthcare waste and end-of-life medication coming from different sources are primary challenges faced by public health leaders. Several factors may be considered critical and inhibitive to reverse logistics within the context of waste management processes. If those factors are not addressed, they may become obstacles to reverse logistics implementation. The purpose of this study is to evaluate the effect that critical factors play in the adoption of end-of-life management practices for medication and its influence on logistics performance. Literature provided some critical factors: management factor, collaboration factor, information technology factor, infrastructure factor, politics factor, financial and economic factor, end-of-life management practices, and logistics performance factor. A sample of 67 professionals from the public pharmaceutical care process answered a structured questionnaire. The collected data was analyzed using partial least square-structural equation modeling. The theoretical structural test confirmed eleven out of the fifteen hypotheses considered. The results have indicated that end-of-life management practices exert a direct influence on logistics performance. The analysis confirmed a direct effect of the information technology factor on end-of-life management practices, but not a moderation effect. Findings have contributed to the literature by providing deeper insights into the relationship between end-of-life management practices for medicines and logistics performance. Moreover, it supports health managers' decision-making in the pharmaceutical care process improvement and engagement with solid waste management policies.

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Healthcare waste (HCW) management is a challenge for establishments that generate this type of waste, especially hospitals, as they are one of the largest generators. A determining factor in waste management is the amount of waste generation, which must be used for management planning. This study aims to compile and evaluate information on the management of HCW generated in Belo Horizonte's (located in Brazil) hospitals declared in their respective Healthcare Waste Management Plans (HCWMP) sent for approval by the municipality's Superintendency of Urban Cleaning. Therefore, a comparative analysis of the hospitals' generations in relation to their characteristics (nature, specialty, and size) was carried out, using the Kruskal-Wallis statistical test with post hoc in Nemenyi. For the study hospitals, a generation rate of 7.18 (6.17-8.23) kg·bed-1·day-1 was estimated, a generation rate close to that of developed countries. When comparing the generation according to the specialty of the hospitals, it was identified that the maternity hospitals (9.00 (7.05-10.90)) kg·bed-1·day-1 had a significantly higher generation rate than the low-complexity hospitals (4.75 (3.28-6.18)) kg·bed-1·day-1. It was also possible to demonstrate that the specialty and size of hospitals influence the structure available for waste storage. Finally, it can be observed that there are few treatment alternatives, with incineration and autoclaving being the technologies most commonly used by hospitals. It is expected that the results presented can serve as a reference for waste managers, in a context where there is little shared information on the subject.

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La gestión de los residuos sanitarios requiere atención especial y todos los equipos sanitarios deben participar en la manipulación de los residuos. Se presta menos atención a la gestión de residuos sanitarios en países en vías de desarrollo y no hay evidencia sobre las prácticas de gestión de residuos sanitarios en algunas instituciones sanitarias. Este estudio se realizó para evaluar las prácticas de gestión de residuos sanitarios y los factores asociados en tres hospitales de Perú. Es un estudio descriptivo, cuantitativo y de corte transversal basado en tres establecimientos de salud. Los datos se recopilaron mediante cuestionarios y listas de verificación de observación. El (66,67%) de los trabajadores conocían sobre el manejo de los desechos biológicos. La mayoría conocía los riesgos asociados con el manejo de los mismos (95,91%). Los participantes tenían el conocimiento de que pueden evitarse las infecciones. Nueve de cada diez de los trabajadores realizaron por lo menos dos capacitaciones en la gestión del manejo de los desechos biológicos. El 95,91% conocía los códigos de colores correctos de los contenedores para diferentes flujos de desechos. En cuanto a las actitudes, 161 (94,15 %) indicó que la gestión de los desechos biológicos era importante y 162 (94,74%) estuvo de acuerdo en que era necesaria una implementación estricta para la gestión adecuada de los mismos en el establecimiento de salud. Elementos clave para mejorar las prácticas de gestión de residuos sanitarios en hospitales: promover prácticas que reduzcan el volumen de residuos generados y aseguren una adecuada segregación de residuos(AU)

Healthcare waste management requires special attention and every healthcare teams should be involved in handling of wastes. However, less attention is paid to health care waste management in developing countries and there is no evidence on health care waste management practices in some institutions providing health services. This study was conducted to assess healthcare waste management practices and associated factors in three hospitals in Peru. It is a descriptive, quantitative and cross-sectional study based on three health establishments. Data were collected using questionnaire and observational checklists. The (66.67%) of the workers knew about the management of biological waste. The majority knew the risks associated with handling them (95.91%). Participants were aware that infections can be prevented. Nine out of ten of the workers completed at least two trainings in the management of biological waste. 95.91% knew the correct container color codes for different waste streams. Regarding attitudes, 161 (94.15%) indicated that the management of biological waste was important and 162 (94.74%) agreed that strict implementation was necessary for proper management of biological waste in the environment health facility. Key elements to improve healthcare waste management practices in hospitals: promote practices that reduce the volume of waste generated and ensure proper waste segregation(AU)

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There are increasing worldwide concerns about the negative impacts of healthcare waste generated in hospitals, especially in low- and middle-income countries. Hazardous type of waste can contribute to adverse effects both in human populations and the environment because of its physical, chemical, and biological characteristics. A comprehensive view on increasing waste in the world has not been conducted to understand the breadth of the issue; thus, this paper sought to provide an analysis of hospitals' healthcare waste generation rate. Comparisons were made with Wilcoxon and Kruskal-Wallis tests for simple and multiple comparisons, to analyze nonparametric data, with post hoc by Nemenyi test. Median values indicated that hospital waste was the highest in North and South America (4.42, 1.64 kg/bed/day, respectively) and was almost nonexistent in Oceania (0.19 kg/bed/day), while the median rates for hazardous waste were the highest in Oceania (0.77 kg/bed/day). Africa was almost the lowest producer of waste in each category (0.19 and 0.39 kg/bed/day for hospital and hazardous waste, respectively). Over time, linear regression indicated that hazardous waste in Asia and Europe has increased, while in Oceania, the total waste also increased. Interestingly, in North America, it was observed a reduction in the generation for both total and hazardous waste. This information highlights the importance of understanding continent-specific characteristics and rates, which can be used to create a more individualized approach to addressing healthcare waste in the world.

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The COVID-19 pandemic has put healthcare waste management (HCWM) systems under pressure worldwide. In Brazil, where municipalities routinely experience challenges in ensuring suitable disposal of healthcare waste (HCW), the pandemic has made this even more challenging. Therefore, the creation of tools and methods to help in municipal HCWM during the COVID-19 pandemic is of utmost importance. This article presents the development of a tool to evaluate HCWM in Brazilian municipalities during the pandemic. Following guidelines of health agencies, 56 indicators and 18 criteria were selected to create a tool called the municipal healthcare waste management assessment index (iMHWaste). These indicators and criteria were divided into operational, environmental, political-economic, educational and social groups. Each group considers essential aspects for sustainable management, safety and reduced spread of coronavirus. The analytic hierarchy process was used to assign the weights attributed to the groups and criteria. The indicators can be measured according to a standardized rating scale proposed for each one. These elements were aggregated with a weighted linear combination, into an equation that allows the calculation of the iMHWaste. The index is rated on a scale of 0-1. The index was applied in a Brazilian municipality considering a pre-pandemic HCWM. With the identification of the municipality's management weaknesses, it was possible to identify the main actions that should be prioritized in the transition from traditional HCWM during the pandemic.

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Coronavirus-19 disease (COVID-19) acquired pandemic status in March 2020. The new virus has caused serious implications in the healthcare services management, including several sectors, among them the generation of waste. Healthcare wastes (HCW) generation increased along pandemic representing a health problem due to potentially infected ones. From this perspective, the study sought to analyse the challenges and changes imposed by COVID-19 in the HCW management in a large public hospital from Brazil. For this purpose, data about the Contingency Plan prepared by the hospital and HCW generation from 2017 to 2020 were used, analysed by statistical methods. When dealing with the Contingency Plan, the Brazilian hospital adopted measures similar to other hospitals around the world as described by the literature, such as: adoption of new protocols, specific team assigned to manage actions and training of professionals and suspension of elective surgeries. Regarding the generation of HCW, there was a significant increase in the mass of biological waste with a high risk of infection. The waste of this group increased from March 2020, coinciding with the start of care for the patients infected by COVID-19. The contribution of this type of waste to total generation jumped from approximately 0.2% in previous years to almost 5% in 2020. In addition, a reduction in the average of total waste generated in kilogrammes per bed per day from 2017 to 2019 was indicated compared to the 2020. COVID-19 pandemic led to major challenges for hospitals that had to care for patients infected with the SARS-CoV-2 virus, including new protocols, changing the work shifts and training the teams in the new procedures. The biological waste with a high risk of infectiousness also increased 30 times.

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With the spread of the new Coronavirus, there was an increase in the generation of contaminated waste. Thus, healthcare waste management (HCWM) became even a greater challenge in hospitals due to Coronavirus easily spread. In this context, it was necessary to create tools that could aid healthcare facilities in evaluating their HCWM. Therefore, the objective of this article was to elaborate a support tool that helps in identifying the shortcomings of hospitals' HCWM. For this purpose, the Health Service Waste Management Index was developed based on the selection of indicators in the area. The index was applied to six hospitals in the state of Minas Gerais, Brazil. Its application meet the purpose of this research, since the results in the form of an index objectively summarize the reality of the HCWM in healthcare facilities. From the six hospitals investigated, four were classified as highly efficient. However, even though most of them were well evaluated, they still have difficulties with properly training their employees, which can be even a worse problem during a pandemic, when every precaution is extremely important to reduce the spread of the disease. Therefore, beyond this article contribution related to sustainability by demanding the hospitals to check which points of HCWM should be improved, it also adds academically by developing a tool with indicators that evaluate operational, human, economic and environmental factors in an innovative way.

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Abstract Hospitals and other health facilities generate an ever-increasing amount of waste, approximately 15% of which may be infectious, toxic, or radioactive. The World Health Organization has been addressing the issue since the 1980s. After initially focusing on high-income countries, it then focused on low-income countries, with unsafe disposal methods in landfills and inadequate incinerators as major concerns. Gradually, the understanding of the issue has undergone several shifts, including from a focus on the component of medical waste considered "hazardous" to all forms of waste, and from accepting medical waste as a necessary downside of high-quality healthcare to seeing the avoidance of healthcare waste as a component of high quality healthcare.

Resumo Hospitais e outros centros de tratamento de saúde geram um volume de resíduos cada vez maior, dos quais cerca de 15% podem ser infecciosos, tóxicos ou radioativos. A Organização Mundial da Saúde começou a enfrentar o problema na década de 1980. Inicialmente, concentrou-se nos países ricos, depois mudou o foco para os países pobres, onde métodos de eliminação inseguros, como aterros sanitários e incineradores inadequados, preocupavam. Aos poucos, a compreensão do problema passou por mudanças, inclusive do enfoque no conteúdo do resíduo hospitalar considerado "perigoso", passando para todas as formas de resíduos, e da aceitação do resíduo médico como um inconveniente inerente aos cuidados de saúde de alta qualidade, até o conceito de que evitar a produção de resíduos hospitalares faz parte dos cuidados de saúde de alta qualidade.

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BACKGROUND: Brasilia, the capital of Brazil, currently has the largest dumpsite of the Americas at Estrutural, with over 30 million tons of waste accumulated. Recyclable waste collectors are a group of workers who, in addition to having a low socioeconomic status and residing in vulnerable areas, work sorting garbage in inadequate and unsanitary areas. This profession puts individuals at risk, resulting in death, mutilation, and disease for workers. OBJECTIVES: The aim of this study was to understand the effects of waste on recyclable collectors, along with their perceptions of associated risks. METHODS: A qualitative study was conducted, using interviews with 34 participants at Estrutural. RESULTS: Collectors were exposed to several hazards, including biological, physical, and more extreme hazards (e.g. being run over by waste trucks). Personal protective equipment was not adequately used, exposing recyclable collectors to injury. Accidents included cuts, burns, skin lesions, eyes lesions, and arm, leg, head, feet, and hand injuries and amputations. Often, homecare remedies and collected medical waste (e.g. pain killers) were used on these injuries instead of seeking out proper medical care. CONCLUSIONS: Recyclable collectors were aware of occupational hazards, but lacked education on the risks and consequences associated with exposure to medical hazards. Moreover, Brazil recently formally closed all dumpsites, complicating this issue. The findings of the present study confirm the need to address these hazards to provide a safe working environment for waste pickers. PARTICIPANT CONSENT: Obtained. ETHICS APPROVAL: This study was approved by the Research and Ethics Committee of the Health School of Brasília University under Opinion n. 1.517.670/2016. COMPETING INTERESTS: The authors declare no competing financial interests.

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Healthcare wastes are generated in facilities whose activities are related to human or animal healthcare. Wastes with high infectious potential risk to human health and the environment must be managed carefully, from generation to its final disposal. However, there is an absence of consolidated data addressing the healthcare waste qualitative classification generated by hospitals of a large city. Therefore, the present study aims to characterise qualitatively the high infectious waste generated by hospitals from Belo Horizonte city, Brazil, whose Health Services Waste Management Plan were approved and certificated by the municipal cleansing autarchy. Differences in the types of infectious wastes generated in maternity hospitals were identified ( p 0.034), when compared with general ( p 0.189), low ( p 0.549) and high complexity ( p 0.619), which can be explained owing to the extended hospital activities. This information suggests a similar profile of the qualitative generation of infectious wastes by hospital categories, as expected. The largest generation and diversity of high-infected wastes are associated with a greater variety of activities provided. The segregation can be considered as the main step in healthcare waste management, therefore, it is concluded that the correct classification leads to a better understanding of all those involved in the healthcare waste management.

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