Environmental Impact of Medical Wastes

Environmental Impact of Medical Wastes Introduction Several incidents concerning medical waste being spotted on public and private beaches have drawn a lot of public attention on the issue of management of medical waste. One such incident happened back in June 1987, when in Indiana polis, twelve children were found playing with blood vials that they had picked from a bin placed outside an HMO medical office.Advertising We will write a custom essay sample on Environmental Impact of Medical Wastes specifically for you for only $16.05 $11/page Learn More Two of these vials were infected with the AIDS virus (10). These issues and others raise concerns on how medical waste is handled, treated and disposed. Medical waste can be defined as all the waste that is generated by health facilities and other sources such as funeral homes, research laboratories, doctor’s clinic funeral homes, nursing homes and veterinary facilities. These wastes consists the hazardous (radioactive materials), infectious also referred to as red bag waste and any other waste generated within the facility (4). Medical waste although not voluminous, is infectious and toxic and leads to serious environmental pollution (1). Background Information According to Environmental protection Agency (EPA), hospitals generate around 3.2 million tons of medical wastes per annum. (10). 10 to 15 0percent of this medical waste generated is infectious. In most hospitals, the non infectious waste is land filled while the infectious one is incinerated. Medical waste requires proper handling, disposal and treatment to minimize the environmental and health risks associated with it. Illegal or careless disposal of medical waste not only creates an aesthetic and health problem, but also increases public apprehension on the existing medical waste management methods. Due to the liabilities and the safety related concerns, some municipals refuse or ban any medical waste from their incinerators and landfills. Various states have prohibited all un-sterilized infectious waste from the municipal landfills.Advertising Looking for essay on ecology? Let's see if we can help you! Get your first paper with 15% OFF Learn More The states have also banned construction of commercial incinerators handling medical waste. These afro mentioned bans, have made it increasingly difficult for medical facilities and hospitals in the country to properly manage medical waste (3). This situation is further complicated by the lack of clear and concise regulatory climate. These inconsistencies are present in the Federal guidelines laid down by the States with regards to the definition of medical waste and the management options available for handling, transporting, treating and disposing medical waste (5). The current situation can only change if the Congress adopts bills relating to medical waste management. In the meantime, most states have been mandated to devise their own plans and programs of managing t he medical waste generated. This means that there are a lot of variations between different states and local requirements. This paper aims at looking at the disposal problems posed by medical waste for both the local government and hospitals, the methods used in disposing medical waste, the long term implications medical waste has on the environment and the conclusions drawn from the discussion (2). Classification of Medical Wastes Medical waste is heterogeneous in nature as it comprises a variety of materials ranging from general waste such as food, office waste and non-infectious waste from patients. It also includes infectious waste e.g. contaminated sharps and blood products, hazardous waste generated from pharmaceuticals, cytotoxic chemicals from chemotherapy, mercury as well as radioactive wastes. Classifying infectious waste has proved difficult due to the variations resulting from different State regulations (10). These different classifications lead to inconsistency in stor age, disposal and treatment practices across different states. The variations also influence the preferred treatment methods, cost of management and eventually, the possible environment and health hazards created by these wastes. Around 10 to 15 percent of all medical waste is infectious but this percentage can differ from 3 to 90 percent, depending on the definition and procedure adopted (10). The state entities, EPA and Centers for Disease Control (CDC) have all tried to find the proper definition of infectious waste based on the characteristics of the waste.Advertising We will write a custom essay sample on Environmental Impact of Medical Wastes specifically for you for only $16.05 $11/page Learn More According to EPA, infectious waste is any waste with the possibility of causing an infectious disease. EPA has broadened its category of infectious waste compared to CDC. This has led to the adoption of EPA instead of CDC guidelines, in hospitals and other areas that generate medical waste, helping in minimizing potential environmental and health risks (4). Another concern is whether to classify infectious waste as hazardous which will increase the cost of managing it due the construction of special facilities. Such a move would improve the management of medical waste, but lead strict regulations and prosecution of illegal dumpers. Some of the wastes recommended to be included in the infectious category are waste from dialysis, stocks and cultures with infectious agents, blood products and human blood, contaminated sharps, soiled dressings, surgical gloves sponges and other surgical waste (6). Varied definition of infectious and hazardous medical waste has led to the public being exposed to this hazardous waste that poses a health risk. For example, the public was barred from accessing beaches in the East coast after bloody bandages, sutures and needles were found in the shores. Infectious waste is sent to the incinerators, thus if th e category was broadened as discussed above, such waste would not have ended up in the beaches (10). Handling of Medical Waste There are various occupational hazards associated with handling medical waste. Waste handlers and health workers are primarily exposed to this type of risk as they more than often handle this waste. Handling hospital waste include packing, storing and transporting it properly to avoid any contamination and littering as discussed below; 1. Packaging- before packaging any medical waste, it must be sorted into different categories and packed accordingly. This is a time consuming activity and quite risky to the handler.Advertising Looking for essay on ecology? Let's see if we can help you! Get your first paper with 15% OFF Learn More Bulk waste is put in polythene bags and colors used in differentiating different categories of wastes. Infectious waste is placed in red bags and all the waste is securely closed in readiness for storage or transportation. Sharps are put in puncture proof containers due to their infectious capability and also due to their prick injuries (7). 2. Storage- hospitals must designate special areas for storing the waste before it is transported or disposed. The area must be regularly disinfected and kept at the right temperature. According to EPA, storage areas must have the bio-hazard symbol and sufficient packaging to prevent vermin’s and rodents from accessing the area. The waste must also be stored for the shortest period possible, although EPA does not give the stipulated period, leading to a State disparity in specified temperatures and times. Lack of uniformity in regulating storage temperature and time can sometimes lead to increased rates of putrefaction and microbial growt h (8). 3. Transportation EPA guidelines address the movement of infectious of waste on-site briefly, and provide limited information on how to move this waste off-site. Such recommendations involve using leak proof and rigid containers to move the waste and not using mechanical loading devices that can rapture packed waste. There are no guidelines on how to handle and transfer medical waste off-site. Although EPA, recommends that hazard labels be put on all medical waste in accordance to Federal, State and municipal regulations, the energy and transport department limit the use of this label, confusing commercial waste handlers (10). Varied definition of infectious waste across different states complicates the matters and increases the likelihood of improper disposal and potential exposure to the public. For example, if a state does not classify bloodied sutures and bandages as infectious waste, it can dispose this waste from another state in the municipal landfill. However, such wa ste can be washed by storm water to the beaches and pose a health risk (9). Methods Used In Disposing Medical Waste Incineration As hospitals generate a lot of waste, both non-infectious and infectious wastes are incinerated together. There is no data on the exact waste incinerated in hospitals or information on the number of current medical incinerators available. Municipal incinerators burn a large volume of waste compared to hospital ones. However, hospital incinerators are situated in highly populated regions, leading to a greater probability of public exposure to toxic fumes and air pollutants. These small incinerators emit higher levels of pollutants, although few risk assessments are carried out, making it impossible to evaluate the risks emanating from these incinerators in comparison to other sources e.g. the municipal incinerators (10). Moreover, the short stacks in hospital incinerators might permit emissions from the incinerators to go into the hospitals via windows and air-conditioning ducts. Hospitals in US use three types of incinerators namely: rotary kiln models, multiple chamber air and controlled air. Most medical waste incinerators are closed air, since they are associated with lower costs and lesser pollution. The advantage associated incinerators is that they can reduce large volumes of waste, sterilize it, and make it possible for it to be disposed traditionally through landfills. Secondly, modern incinerators harness the heat created during the process and use it to power generators within the facility (8). Autoclaves Autoclaving uses steam sterilization in treating wastes before they are sent off to the landfills. Autoclaving is done in closed compartments, where pressure and heat are applied generating steam, within a given length of time so as to sterilize medical apparatus. All microorganisms found in the medical waste are destroyed by the steam generated and then disposed off disposed in landfills. After autoclaving medical waste, it undergoes compaction through shredding so that it is not used for any other purposes and then later on disposed in the landfills. However, autoclaving is not recommended for pathological waste due to the presence of low levels of radiation. The advantage of this method is that it can be used in processing 90 percent of medical waste and compaction reduces the volume of waste after (7). Long term Environmental Implications of Medical Waste Improper disposal of medical waste have far reaching environment impacts. Disposal of medical waste in oceans or other water bodies can lead to contamination of water by the pathogens found in this waste. Medical wastes such as soiled bandages or plastic gloves destroy the aesthetic appearance of the environment when they litter the beach or other places. On the other hand, the disposal methods used in getting rid of the medical waste causes serious air pollution. According to a JAMA study carried out in 2009, the health sector accounts for 8 pe rcent carbon emission (8). Most of the medical waste is plastic that produces furans and dioxins during combustion. Most old medical incinerators have no equipment for controlling pollution. The incinerator ash generated from combusting contaminated waste may contain potentially toxic chemicals that will end up in the landfill and cause environmental pollution. When autoclaving is used in disposal, the waste might not completely sterilized since the density and volume of material being sterilized determine the effectiveness of the process (7). There is a possibility of incomplete sterilization if the autoclave is overloaded and these pathogens will end up in the landfill, polluting the environment and posing a health risk to the public. Conclusion From the discussion above, it is clear that poor regulatory framework has hindered proper management of medical waste disposal. Medical waste is disposed through incineration and autoclaving, but both methods cause environmental pollution and pose a risk to the public health. Incineration releases toxic gases, while in autoclaving there is the risk of incomplete sterilization, transferring pathogens to the landfills. It is important for medical facilities to adopt new technology in waste disposal to reduce the environmental pollution. References Landrum, VJ. Medical waste management and disposal. California:William Andrew; 1991. NBCE. Medical, municipal and plastic waste management handbook. New Delhi: National Institute of Industrial Re; 2007. Office of technology Assessment. Finding the Rx for managing medical wastes. Washington DC: Diane Publishing; 1990. Friedman, M M and Rhinehart, E. Infection Control in Home Care. Sudbury: Jones Bartlett Learning; 1999. Hunt, DL and Fleming, D. Biological safety: principles and practices. Washington DC: ASM Press; 2000. Bassey, BE, Benka-Coker, MO and Aluyi, HAS. Characterization and management of solid medical wastes in the Federal Capital Territory, Abuja Nigeria. Afri H ealth Sci. 2006 March; 6(1): 58–63. Uzych, L. Medical waste management: regulatory issues and current legal requirements. J Environmental Health, 1990 May, 52 (3): 30-35. Pyrek, KM. Infection control today. Phoenix Virgo publishing; 2010 November 16. Web. Hossetti, BB. Prospects and Perspective of Solid Waste Management. Seborga: New Age International; 2006. Federation of American scientists. Washington DC: The Association; c1988-2002. Group and Physicians Workshop: [about 3 screens]. Web.

Visa CMPP para mdicos cubanos y otros profesionales

Visa CMPP para mdicos cubanos y otros profesionales La visa CMPP se concedà ­a a mà ©dicos y otro personal sanitario cubano que trabajaban en una misià ³n internacional fuera de Cuba. Este era uno de los programas migratorios de Estados Unidos que aplicaba sà ³lo a cubanos. Con fecha del 12 de enero de 2017, el gobierno de los Estados Unidos decidià ³ poner fin a este programa al igual que a la polà ­tica de pies secos, pies mojados. CMPP eran  las siglas en inglà ©s del Programa para Profesionales Mà ©dicos Cubanos. Esta visa, que  a pesar de su nombre no era  realmente una visa sino un parole, tenà ­a reglas estrictas que habà ­a que conocer para evitar quedar en situacià ³n problemtica, es decir, como un desertor para los cubanos y sin visa para los estadounidenses.  ¿Quià ©nes se podà ­an  beneficiar de CMPP? Se debà ­an  reunir todas las caracterà ­sticas siguientes: Ser ciudadano o nacional cubanoEstar trabajando o estudiando como profesional mà ©dico en un tercer paà ­s en una misià ³n bajo la direccià ³n del gobierno de Cuba.No estar afectado por ninguna de las circunstancias que convierten a una persona en inelegible o inamisible para ingresar a Estados Unidos. Es decir, no aplicaba a los mà ©dicos que estaban por ejemplo, como turistas en Venezuela o en otro paà ­s.  ¿Quià ©nes eran  profesionales sanitarios para estos efectos? Entre otros, los siguientes: Mà ©dicosParamà ©dicosEnfermerosEntrenadores deportivosFisioterapistasTà ©cnicos de laboratorio  ¿Y quà © pasaba con los familiares? Bajo el programa de visas CMPP los  familiares  de los mà ©dicos que la solicitaban  podrà ­an tambià ©n beneficiarse y viajar legalmente a Estados Unidos con determinadas condiciones. Para empezar, eran  familiares a estos efectos el cà ³nyuge del personal mà ©dico que aplicaba y tambià ©n sus hijos solteros menores de 21 aà ±os. Nadie ms. Si estos familiares estaban  fuera de Cuba acompaà ±ando al profesional, se podà ­a considerar aprobarles un parole al mismo tiempo. Sin embargo, si estaban  en Cuba, habà ­a que esperar a que el beneficiado de una visa CMPP ingresara a los Estados Unidos y una vez aquà ­ podrà ­a reclamarlos.    ¿Quà © pasa con las personas que han solicitado  la visa CMPP pero todavà ­a no tienen respuesta? Ahora ya no se pueden solicitar ms, pero el personal que las solicità ³ y est pendiente de su aprobacià ³n podrn seguir con dicha tramitacià ³n.  ¿Quà © pasa desde el punto de vista migratorio cuando se ingresa a USA? Una vez en Estados Unidos, al aà ±o y un dà ­a se podr solicitar la tarjeta  de residente permanente. Mientras no se obtiene y se est en esa tramitacià ³n, no salir de Estados Unidos sin un permiso que se conoce como advance parole.   Una vez que se obtiene la residencia, que tambià ©n se conoce como green card y  con el transcurrir de los aà ±os, se puede solicitar la ciudadanà ­a americana  mediante el trmite de la naturalizacià ³n. El problema de la revlida del tà ­tulo de mà ©dico una vez que se llega a Estados Unidos Los mà ©dicos cubanos, al igual que todos los que obtuvieron sus tà ­tulos universitarios en un paà ­s distinto a los Estados Unidos, deben examinarse para acreditar su titulacià ³n y asà ­ estar capacitados legalmente para trabajar como mà ©dicos. Y en la actualidad esto est resultando ser un problema por dos razones principales. La primera es el alto costo de los exmenes de la ECFMG y de USMLE, que son organizaciones privadas encargadas de gestionar los test. En la actualidad, es necesario aprobar 4 exmenes. Y, en segundo lugar, el altà ­simo conocimiento de inglà ©s que se requiere. Y es que hay que contestar a ms de 400 preguntas en un tiempo limitado, lo que complica la obtencià ³n de la revlida a profesionales cuyo lengua materna no es el inglà ©s. El efecto principal de estas trabajas es que a pesar de que en la actualidad existe en los Estados Unidos un dà ©ficit de aproximadamente 65,000 mà ©dicos y de que los profesionales cubanos llegan al paà ­s con documentos que les permiten trabajar, muchos de ellos acaban desempeà ±ndose profesionalmente no como mà ©dicos, sino como auxiliares, despuà ©s de obtener las debidas licencias. Los mà ©dicos cubanos recià ©n llegados pueden contactar con Solidaridad sin fronteras (SSF) en Hialeah, Florida, ya que es una organizacià ³n conocida por brindarles ayuda para navegar y entender estos problemas burocrticos. Puntos bsicos de CMPP Desde que se creà ³ el programa de CMPP en 2006, segà ºn datos oficiales del Servicio de Inmigracià ³n y Ciudadanà ­a (USCIS, por sus siglas en inglà ©s), ms de 7,000 mà ©dicos y otros profesionales sanitarios cubanos han obtenido esta visa. De hecho, se han producido solicitudes desde 65 paà ­ses. Si bien la aproximadamente la mitad de las peticiones se han realizado en Caracas, ya que la misià ³n sanitaria de cubana en Venezuela es de considerable tamaà ±o. Otras embajadas activas en la emisià ³n de estas visas son las de Colombia y las de Curacao, donde los solicitantes proceden de la vecina Venezuela. El nà ºmero de beneficiados ha aumentado recientemente, y asà ­ en el à ºltimo aà ±o fiscal un total de 1,663 profesionales obtuvieron la CMPP. De interà ©s para los profesionales mà ©dicos Los profesionales sanitarios que se desempeà ±an fuera de los Estados Unidos se preguntan frecuentemente cunto ganan sus colegas aquà ­. Este es el  sueldo  medio de enfermeras en Estados Unidos.  Incluso  ganan ms los mà ©dicos, aunque hay variaciones segà ºn especialidad. Este es un artà ­culo informativo. No es asesorà ­a legal.