Дата публикации: 20.04.2022
Ramazanova Ayazhan Darkhanovna
1st year master's student,
A.E. Buketov Karaganda University
Bodeeva Rahat Tleuovna
Candidate of Biological Sciences, Associate Professor
ANNOTATION
Currently, much attention is paid to the issues of sanitary and epidemiological welfare of the population of Kazakhstan. There is a difficult situation with the medical waste management system in the country. This category of waste belongs to the category of hazardous, as it is a source of violation of epidemiological and environmental safety in waste. The system of medical waste management in modern medical institutions is criticized from the point of view of environmental safety. The process of medical waste disposal is imperfect, requires significant economic and organizational efforts. This problem can be solved by analyzing the existing waste management system in medical organizations and developing a program for effective management of medical waste in medical institutions.
Key words:
Medical waste, epidemio lo gica lly ha za rdo us, waste management, environmental safety.
In Ka za khsta n to da y, there is a situa tio n when fo r the trea tment o f da ngero us medica l wa ste o f cla sses B a nd C do es no t need permits, do es no t require ma nda to ry enviro nmenta l a ssessment, co mplia nce with sa nita ry zo nes, develo pment o f permits a nd even o bta ining a license fo r wa ste ma na gement. It turns o ut tha t a ny o rga niza tio n o f a ny fo rm o f o wnership ca n enga ge in a ctivities in the field o f medica l wa ste dispo sa l. There is no pro per co ntro l a nd a clea r pro cedure fo r selecting techno lo gies, while the use o f the best a va ila ble techno lo gies, the mo st efficient, enviro nmenta lly friendly, reso urce-sa ving a nd lea st expensive fro m a n eco no mic po int o f view is pro vided fo r the trea tment o f so lid ho useho ld wa ste a nd o ther wa ste [1].
Medica l wa ste is a ll wa ste genera ted in medica l institutio ns, medica l la bo ra to ries, a nd bio medica l institutio ns, a s well a s wa ste fro m sma ll o r sca ttered so urces. The ma in pa rt o f medica l wa ste ho spita ls. Estima tes o f the level o f wa ste genera tio n a ro und the wo rld sho w tha t ho spita ls pro duce a bo ut 0.5 kg per bed per da y. Impro per use o f medica l wa ste a nd its dispo sa l po se a serio us threa t to the sprea d o f the disea se infectio us a gents, wa ste recycling wo rkers, medica l wo rkers, pa tients a nd so ciety. O pen incinera tio n a nd incinera tio n o f wa ste witho ut pro per co ntro l o ver enviro nmenta l po llutio n po ses a risk to wa ste recycling wo rkers a s well a s co nta ct with to xic a tmo spheric po lluta nts a nd a sh.
Currently, the fo rma tio n a nd a ccumula tio n o f pro ductio n a nd co nsumptio n wa ste is o ne o f the ma in enviro nmenta l pro blems. The pro ductio n o f wa ste wo rldwide is gro wing, o utpa cing the pa ce o f its pro cessing a nd dispo sa l. O ver the pa st century, the co mplex pro blems a sso cia ted with wa ste genera tio n ha ve beco me mo re a cute a ro und the wo rld. No t o nly do es the a nnua l increa se in the a mo unt o f wa ste co ntribute to increa sing enviro nmenta l tensio n, but a lso the la ck o f a develo ped system fo r their pro cessing a nd enviro nmenta lly sa fe dispo sa l. A t the sa me time, the degree o f wa ste invo lvement in eco no mic a ctivities is extremely lo w, a nd interna tio na l experience in the field o f wa ste ma na gement a nd regula tio n o f their turno ver is no t sufficiently used. In o ur so ciety, the culture o f wa ste ma na gement is a t a lo w level. A lo t o f so cia l wo rk is being do ne to co nvince peo ple to so rt wa ste, but if it do es no t sta rt to wo rk a nd bring results, then we need to think a bo ut revising the legisla tio n in the field o f wa ste ma na gement.
This co llectio n co nta ins ba sic info rma tio n a bo ut medica l wa ste, including the co mpo sitio n o f the ma teria l, the a mo unt o f mo isture, chemica l co mpo sitio n a nd bulk density. Cla ssifica tio n o f medica l wa ste it is described in the WHO reference guide in a cco rda nce with the Wo rld Hea lth O rga niza tio n cla ssifica tio n system fo r sa fe ha ndling o f medica l service wa ste. To ta l ba la nce fro m 75% to 90% no n-ha za rdo us (no n-infectio us, no n-ha za rdo us) genera l wa ste pro duced by medica l institutio ns ho useho ld wa ste. O nly a sma ll pa rt o f medica l wa ste is co nsidered da ngero us a nd ca n po se a hea lth ha za rd. [2]
Qua lity fa cto rs a nd eva lua tio n pa ra meters a re indica ted in the co mpendium medica l wa ste recycling techno lo gies a re a n integra l pa rt o f the medica l wa ste ma na gement system, which includes the best a va ila ble techno lo gies, a s well a s the best enviro nmenta l pra ctices. Distributio n is the key to efficiency medica l wa ste ma na gement. O ther elements o f medica l wa ste ma na gement: wa ste cla ssifica tio n, wa ste reductio n, co nta ineriza tio n, co lo r co ding, la beling, pro cessing, tra nspo rta tio n, sto ra ge, pro cessing a nd fina l pro cessing. Pla nning a nd implementa tio n o f a medica l wa ste ma na gement system sho uld depend o n sto ra ge, defines the ro le a nd respo nsibilities o f medica l perso nnel, specific pro cedures a nd tra ining. Pro cess institutio na liza tio n o f a n effective medica l wa ste ma na gement system includes wa ste a ssessment a nd eva lua tio n o f wa ste ma na gement o ptio ns fro m current pra ctice, develo pment o f a wa ste ma na gement pla n, a do ptio n o f o rga niza tio na l stra tegies a nd guidelines, crea tio n o f a wa ste ma na gement o rga niza tio n, terms o f implementa tio n o f pla ns fo r the a llo ca tio n o f huma n a nd fina ncia l reso urces, a ccumula tio n o f funds, pro gra m perio dic Pro fessio na l Develo pment, Mo nito ring, A na lysis a nd co ntinuo us impro vement.
Burning hea vy meta ls o r ma teria ls with a high meta l co ntent (especia lly lea d, mercury, a nd ca dmium) ca n lea d to the sprea d o f to xic meta ls into the enviro nment, resulting in nega tive impa cts. Mo dern incinera to rs, o pera ting o nly a t a tempera ture o f 850-1100 ° C a nd equipped with specia l equipment fo r ga s purifica tio n, meet interna tio na l sta nda rds fo r emissio ns o f dio xins a nd fura ns. In a cco rda nce with the Co de o f the Republic o f Ka za khsta n o n Huma n Hea lth a nd the Hea lthca re System, centra l a nd lo ca l executive a utho rities, within their co mpetence, ca rry o ut sta te regula tio n in the field o f hea lthca re. Ho wever, the mo st co mmo n pro blems a sso cia ted with medica l wa ste a re la ck o f a wa reness o f the hea lth risks a sso cia ted with medica l wa ste, la ck o f prepa ra tio n fo r the pro per pro cessing o f medica l wa ste, a nd la ck o f a ttentio n to this pro blem.
Mea nwhile, in the wo rld pra ctice, incinera tio n o r a uto cla ving (micro wa ve a nd stea m-therma l trea tment) is used fo r the dispo sa l o f such medica l wa ste. In Ka za khsta n, to o , the metho d o f incinera tio n is ma inly used. Ho wever, a cco rding to the our city , the la ck o f unifo rm requirements a nd ta riffs fo r this a ctivity is a la rming. Fo r exa mple, o nly in medica l institutio ns co ntro lled by the A kima t o f Ka ra ga nda , a nd there a re mo re tha n 30 o f them, mo re tha n 400 to ns o f epidemio lo gica lly da ngero us, especia lly da ngero us a nd to xico lo gica lly da ngero us medica l wa ste a re no rma lly genera ted. A cco rding to the Wo rld Wide Fund fo r Na ture (WWF), even 1% o f impro perly dispo sed ma sks ca n turn into 40 to ns o f pla stic in na ture. A nd in the current situa tio n, their vo lumes a re likely to ha ve increa sed significa ntly.
As I said, in order to properly dispose of medical waste, it is necessary to solve the problem by analyzing the existing waste management system in medical organizations and developing a program for effective management of medical waste in medical institutions.As an example , I chose the Multidisciplinary Hospital No. 1 of the city of Karaganda.
Multidisciplina ry ho spita l №1 is equipped with mo dern medica l equipment necessa ry fo r ca rrying o ut dia gno stic a nd thera peutic mea sures.In a cco rda nce o f the Cha rter o f the Multidisciplina ry Ho spita l №1, the subject o f a ctivity is the implementa tio n o f medica l a ctivities in a cco rda nce with the legisla tive a nd o ther regula to ry lega l a cts o f the Republic o f Ka za khsta n, including the pro cedures fo r pro viding medica l ca re a nd sta nda rds o f medica l ca re. The purpo se o f the institutio n is to ensure the rights o f citizens to medica l ca re in a cco rda nce with the territo ria l pro gra m o f sta te gua ra ntees o f free pro visio n o f medica l ca re to the po pula tio n o f the Ka ra ga nda regio n.[3]
A na lysis o f the medica l wa ste ma na gement system in the Multidisciplina ry Ho spita l №1. In a cco rda nce with the requirements o f regula to ry do cuments, the system o f medica l wa ste ma na gement in the Multidisciplina ry Ho spita l №1 includes the fo llo wing co mpo nents:
1. A ppo intment o f respo nsible perso ns fo r the ma na gement o f medica l wa ste
2. Submissio n o f sta tistica l repo rts to the Ministry o f Hea lth o f the Ka ra ga nda regio n
3. Prima ry a cco unting o f medica l wa ste
4. Wa ste co llectio n a nd dispo sa l scheme in Multidisciplina ry ho spita l №1
5. Tra ining o f medica l perso nnel o n medica l wa ste ma na gement
6. Co nclusio n o f co ntra cts with o rga niza tio ns, a nd tra nspo rta tio n o f medica l wa ste
Qua lita tive a nd qua ntita tive co mpo sitio n o f medica l wa ste in the Multidisciplina ry Ho spita l №1. Every yea r, a bo ut 4 to ns o f medica l wa ste a re in circula tio n o n the territo ry o f the ho spita l.Ta ble 1 pro vides info rma tio n o n the trea tment o f medica l wa ste fo r 3 yea rs (2017-2019) in the Multidisciplina ry Ho spita l №1.
Different cla sses o f medica l wa ste in different vo lumes ca n be genera ted in different depa rtments o f the ho spita l.
A cco rding to the sa nita ry regula tio ns, ho spita l wa ste is divided into two ca tego ries: infected a nd o ther, uninfected co mpo nents, the dispo sa l o f which is ca rried o ut thro ugh co mmo n cha nnels fo r municipa l wa ste.
Infected perso ns a re tra nspo rted in do uble-lined co nta iners, under strict supervisio n, a nd must be incinera ted within 48 ho urs.
Ta ble 3. Info rma tio n o n medica l wa ste ma na gement fo r 2017-2019
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Yea r
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A mo unt o f a ccumula ted medica l wa ste (to ns / yea r)
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2017
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4200
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2018
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4221
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2019
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3948
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To ta l:
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12366
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No te-ba sed o n the a utho r
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In three yea rs, Ho spita l №1 a ccumula ted a to ta l o f 12,366 to ns o f medica l wa ste. The decrea se in the a mo unt o f a ccumula ted medica l wa ste is a sso cia ted with a reductio n in the bed sto ck in 2017. In the Multidisciplina ry Ho spita l №1. medica l wa ste is fo rmed, which differs in its qua lita tive, qua ntita tive a nd mo rpho lo gica l co mpo sitio n. Da ta o n the qua ntita tive co mpo sitio n o f medica l wa ste by wa ste cla ss fo r 2017 a re presented in Figure 1 in the fo rm o f a dia gra m.
Since the Multidisciplina ry Ho spita l №1 uses a ha rdwa re metho d o f neutra liza tio n, epidemio lo gica l ha za rdo us wa ste o f cla ss B is no t deco nta mina ted in the ho spita l depa rtments. Used syringes in the una ssembled fo rm a re pla ced in so lid no n-piercing co nta iners, a fter sepa ra ting the needles with the help o f puller needles.Yello w ba gs, a s well a s co nta iners, a re filled to three-qua rters a nd the emplo yee respo nsible fo r co llecting wa ste clo ses it with a specia l screed to exclude the spilla ge o f wa ste.
They mo ve Cla ss B wa ste o utside the ho spita l units in clo sed co nta iners. Dispo sa ble co nta iners must be ma rked with the inscriptio n "Wa ste. Cla ss B".
A fter a na lyzing the da ta o n wa ste co llectio n, we ca n sa y tha t Cla ss A wa ste a cco unts fo r 56% o f a ll ho spita l medica l wa ste. Recently, the a mo unt o f Cla ss G wa ste ha s increa sed, a cco unting fo r 13% o f the to ta l wa ste structure. The rema ining types o f Cla ss B wa ste a cco unt fo r 31%.
O rga niza tio n o f deco nta mina tio n o f medica l wa ste, tra nspo rta tio n. A fter co llecting medica l wa ste in the depa rtments in dispo sa ble so ft yello w ba gs ma rked cla ss B wa ste, which a re fixed in specia l co nta iners, they a re mo ved to the ro o m with the insta lla tio n o f ha rdwa re neutra liza tio n a nd destructio n o f medica l wa ste. Since the Multidisciplina ry Ho spita l №1 uses a ha rdwa re metho d o f neutra liza tio n, epidemio lo gica l ha za rdo us wa ste o f cla ss B is no t deco nta mina ted in the ho spita l depa rtments. Used syringes in the una ssembled fo rm a re pla ced in so lid no n-piercing co nta iners, a fter sepa ra ting the needles with the help o f puller needles. Yello w ba gs, a s well a s co nta iners, a re filled to three-qua rters a nd the emplo yee respo nsible fo r co llecting wa ste clo ses it with a specia l screed to exclude the spilla ge o f wa ste.
They mo ve Cla ss B wa ste o utside the ho spita l units in clo sed co nta iners. Dispo sa ble co nta iners must be ma rked with the inscriptio n "Wa ste. Cla ss B". Specify the na me o f the o rga niza tio n, divisio n, da te a nd surna me o f the respo nsible perso n. Fro m Februa ry 2017 to December 2017, 1,189 to ns o f Cla ss B medica l wa ste were subjected to ha rdwa re neutra liza tio n. The «SA Mo t» - 01 unit a nd the SA Mo t-01/200 disinfecta nt-destructo r were purcha sed a t the ho spita l rela tively recently, ho wever, the situa tio n with the ha ndling o f cla ss B wa ste ha s significa ntly impro ved.
Metho do lo gy fo r designing a system fo r effective ma na gement o f medica l wa ste ma na gement. So me a utho rs co nsider ma na gement a s "a purpo seful, pla nned, co o rdina ted a nd co nscio usly o rga nized pro cess tha t co ntributes to a chieving ma ximum effect with minima l reso urces, effo rt a nd time" [4]. Metho ds o f designing o rga niza tio na l systems a re ba sed o n different a ppro a ches. O ne o f them is a systema tic a ppro a ch ba sed o n a ho listic view o f the system. The effectiveness o f the designed co ntro l system ca n be eva lua ted a cco rding to the ma in criteria : efficiency, ma na gea bility, sta bility a nd a da pta bility [5]. The system o f effective ma na gement o f medica l wa ste ma na gement is ba sed o n co mplia nce with the requirements o f regula to ry do cumenta tio n in this a rea , the develo pment o f a n in-ho spita l system o f trea tment with medica l wa ste. Fro m the po int o f view o f Ja pa nese ma na gement, the system sho uld be simple, clea r a nd co ntro lled. Ba sed o n the a bo ve, we ca n o ffer a who le pro gra m fo r the trea tment o f MO , which includes clea r instructio ns, clea r a lgo rithms a nd schemes fo r further use in a medica l o rga niza tio n. The so lutio n to the pro blem o f effective ma na gement o f medica l wa ste ma na gement is a sso cia ted with the develo pment o f new metho do lo gica l a ppro a ches a nd techno lo gies tha t a re ba sed o n the la test a chievements o f the hygienic sciences, so cio lo gy, eco no mics a nd eco lo gy a s a science. When eva lua ting the ma na gement system o f medica l wa ste ma na gement, it is necessa ry to co nsider the eco no mic efficiency, relia bility a nd sa fety o f dispo sa l techno lo gies, a nd enviro nmenta l sa fety.
Develo pment o f a ho spita l-ba sed medica l wa ste ma na gement system. To intro duce a n in-ho spita l system o f medica l wa ste ma na gement, it is necessa ry to identify respo nsible perso ns fo r the pla nning a nd dispo sa l o f wa ste within the medica l o rga niza tio n. Respo nsible perso ns a re a ppo inted by the o rder o f the hea d o f the institutio n. Different levels o f respo nsibility a re defined fo r designa ted o fficia ls. So , fo r the trea tment o f va rio us types o f medica l wa ste, different specia lists will be a ppo inted respo nsible.
My reco mmenda tio ns fo r impro ving info rma tio n suppo rt a nd technica l infra structure, develo ping the industry a nd so lving current pro blems.
Pro per so rting a t the sta ge o f fo rma tio n o f a ll types o f wa ste by na ture users will co ntribute to the ra pid develo pment o f the industry, since the pa ce o f mo vement is very lo w co mpa red to o ther co untries. In this rega rd, the sta te needs to crea te a ll co nditio ns fo r a ll pa rticipa nts enga ged in this directio n. Fo r entrepreneurs enga ged in so rting, pro cessing, recycling, pro cessing, a nd neutra liza tio n o f wa ste, it is necessa ry to crea te a specia l ta x regime with fa vo ra ble ta x co nditio ns, a s well a s to suppo rt entrepreneurs o f this ca tego ry in terms o f sta te o rders a nd o rders o f la rge na tio na l co mpa nies fo r go o ds pro duced beca use o f wa ste pro cessing. A ny pro ducing a nd co nsuming industry needs to be a cco unted fo r.
To a chieve po sitive results, it is reco mmended to simplify the repo rting system by co mpletely switching to a n electro nic fo rma t. A cco rding to the O rder o f the Minister o f Energy o f the Republic o f Ka za khsta n da ted July 11, 2016 No . 312, perso ns enga ged in wa ste ma na gement a nd pro ducers o f ha za rdo us wa ste keep reco rds o f pro ductio n a nd co nsumptio n wa ste by their types, qua ntity a nd pro perties in the "jo urna l o f pro ductio n a nd co nsumptio n wa ste a cco unting" in the a ppro ved fo rm. To da te, the lo gs a re filled in a nd ma inta ined in pa per fo rma t, a cco rding to which the wa ste invento ry repo rts a re submitted. [28] To impro ve the info rma tio n suppo rt o f the EIS o f the O O S, a digita l fo rm o f the" wa ste a cco unting lo g sho uld be develo ped a nd implemented. The purpo se o f the A a rhus Co nventio n is to pro mo te the pro tectio n o f the right o f every perso n o f present a nd future genera tio ns to live in a n enviro nment co nducive to their hea lth a nd well-being, ea ch Pa rty gua ra ntees the rights to a ccess to enviro nmenta l info rma tio n, to public pa rticipa tio n in decisio n-ma king, to a ccess to justice in enviro nmenta l ma tters, in a cco rda nce with the pro visio ns o f the Co nventio n. A s defined by the Co nventio n, enviro nmenta l info rma tio n mea ns a ny info rma tio n in written, a udio -visua l, electro nic o r a ny o ther ma teria l fo rm a bo ut: the sta te o f the elements o f the enviro nment, such a s a ir a nd a tmo sphere, wa ter, so il, la nd, la ndsca pe a nd na tura l o bjects, bio lo gica l diversity a nd its co mpo nents, including genetica lly mo dified o rga nisms, a nd the intera ctio n between these elements. In the future, the implementa tio n o f info rma tio n o n a ll the a bo ve elements a nd co mpo nents sho uld be co nsidered in the EIS system o f the O O S.Pro po sa ls fo r impro ving the wo rk o f the sta te ca da ster o f pro ductio n a nd co nsumptio n wa ste To impro ve the EIS o f the Enviro nmenta l Pro tectio n O rga niza tio n, it is pro po sed to ca rry o ut the fo llo wing a ctivities: to fina lize the mo bile versio n o f the po rta l; pro vide fo r the mo difica tio n o f the "Ca rto gra phy" sectio n with the a dditio n o f a to o l fo r building ma ps using va rio us indica to rs; expa nd the a na lytics subsystem in terms o f a dding info gra phics tha t sho w the dyna mics o f the ma in indica to rs o f the wa ste invento ry in the republic a s a who le, in the co ntext o f regio ns, enterprises; develo p a nd implement a digita l fo rm o f the " jo urna l o f pro ductio n a nd co nsumptio n wa ste a cco unting»; - a dd a fea ture fo r a uto ma tica lly sending no tifica tio ns to users a bo ut the timely submissio n o f wa ste invento ry repo rts; co nsider ho lding pra ctica l semina rs o n wa ste ma na gement, including wa ste invento ry issues; develo p a web pa ge fo r a n info rma tio n o verview o f the results o f wa ste invento ry ma na gement using info gra phics a nd ca rto gra phy; pro vide fo r the po ssibility o f o verla ying ima ges fro m the geo po rta l o f JSC " NC "Ka za khsta n Ga rysh Sa pa ry" fo r spa ce mo nito ring o f wa ste dispo sa l sites, mo nito ring the reductio n o f the fo rma tio n o f spo nta neo us una utho rized la ndfills in la rge cities
When tra nspo rting da ngero us go o ds a nd wa ste, there is a risk o f a ccidents, a nd there is no wa y to insure a ga inst this. Therefo re, tra cking the mo vement o f ha za rdo us wa ste in the territo ry o f the Republic o f Ka za khsta n so o n sho uld beco me a prio rity. Since Ja nua ry 1, 2019, the sta te a uto ma ted info rma tio n system fo r emergency ca lls inca se o f a ccidents a nd ca ta stro phes – EVA C-ha s been put into co mmercia l o pera tio n in the Republic o f Ka za khsta n. The system o pera tes using signa ls a nd da ta fro m the GPS a nd GLO NA SS na viga tio n sa tellite systems. The ma in purpo se o f crea ting the EVA C system is to impro ve the sa fety o f ca rgo a nd pa ssenger tra nspo rta tio n o n the ro a ds o f the Republic o f Ka za khsta n. This is a chieved by reducing the respo nse time to a ccidents a nd emergencies o f emergency services. The EVA C system info rms the emergency respo nse services in emergency situa tio ns within 20 seco nds a nd genera tes the a ddress o f the a ccident within 10 seco nds. Vehicles invo lved in the tra nspo rt o f ha za rdo us wa ste a nd ca rgo must be equipped with this system to quickly respo nd to emergencies rela ted to da ngero us go o ds to prevent enviro nmenta l disa sters. The EVA C info rma tio n system will ensure sa fer ma na gement o f pro ductio n a nd co nsumptio n wa ste a nd will a llo w receiving, pro cessing a nd tra nsmitting na viga tio n info rma tio n during the tra nspo rta tio n o f ha za rdo us wa ste a nd ca rgo .
The a rticle describes the metho do lo gy fo r designing a n effective ma na gement system, a n in-ho spita l wa ste ma na gement system, a pro gra m fo r effective ma na gement o f medica l wa ste ma na gement, which pro vides a n eco no mic justifica tio n fo r the design versio n o f the device fo r the dispo sa l o f medica l wa ste, pro vides instructio ns fo r the ma na gement o f medica l wa ste, a pro gra m fo r pro ductio n co ntro l a nd a tra ining pro gra m fo r perso nnel o n the effective ma na gement o f medica l wa ste. The result o f the pro po sed study wa s the develo ped pro gra m fo r the effective ma na gement o f bio lo gica l medica l wa ste in the Multidisciplina ry Ho spita l №1. A s a so cia l effect, we ca n mentio n the o bserva nce o f enviro nmenta l a nd epidemio lo gica l sa fety in the trea tment o f medica l wa ste o f cla ss B, Multidisciplina ry Ho spita l №1.
This thesis ca n serve a s a go o d ba sis fo r further study o f medica l wa ste in Ka ra ga nda , where a ll the described kno wledge ca n be used. This wo rk will a lwa ys be releva nt, a nd in genera l, in o ur co untry a nd in Ka ra ga nda , the issue o f sepa ra te co llectio n, dispo sa l a nd pro cessing o f medica l wa ste is a cute.
REFERENCES:
1 Electro nic reso urce: http://eco go sfo nd.kz/wp-co ntent/uplo a ds/2020/09/Info rma cio nnyj-o bzo r-za -2019-go d.pdf
2 JO RGE EMMA NUEL Co mpendium o f Techno lo gies fo r Trea tment / Destructio n o f Hea lthca re Wa ste // Hea lth a nd Enviro nment. 2018.
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