BACKGROUND: Hospitals generate variety of waste which is hazardous to patients, health workers, community, and environment. Proper health-care waste management (HCWM) requires infrastructure, trained workforce, law and supervision. More than 80% of the population of Tripura depends on the public health-care system but the knowledge and practice of health-care workers regarding HCWM in the public sector of Tripura is not clear.
OBJECTIVE: The objective was to assess the knowledge and practice of health-care workers regarding HCWM and to take an account of the existing HCWM facilities in the public sector of Tripura.
METHODS: This was a facility-based, cross-sectional study.
METHODS: This study was conducted during 1st November 2015 to 16th October 2017 among 544 health-care workers working in thirty health institutions chosen by stratified random sampling. Data entry and analysis was performed using SPSS software version 15.0.
RESULTS: Overall, 37.68% of the respondents had fair knowledge regarding HCWM, 8.27% received in-service training on HCWM, 66.17% were immunized against hepatitis B and > 90% of the respondents knew about segregation of waste at source but knowledge regarding the use of colored bins for this purpose varied widely across different categories of participants. Housekeeping staff were ignorant about most of these issues. The importance of disinfecting the waste before disposal was known to 83.63% of the workers. Proper HCWM was practiced by 39.15% and segregation of waste at source into colored bins was followed by 23.3% of the respondents. The study revealed both waste management facilities and display of waste management policy as poor. Technical qualification and in-service training were identified as the statistically significant determinants of knowledge and practice of HCWM (P < 0.05).
CONCLUSIONS: HCWM scenario including knowledge of health-care workers in Tripura is lacking. Installing proper waste management facilities, raising technical qualification at recruitment and in-service training may improve the situation.

Health-care waste management is a challenge for the health sector. Currently, pyrolysis technologies are being used to treat medical waste that can convert it to a hydrocarbon fuel. In the present study, hazardous health-care waste was pyrolyzed using a continuous tubular fast pyrolysis reactor. Mass balance analysis and formation of the 16 polycyclic aromatic hydrocarbons (PAHs), characterized by USEPA as priority pollutants, and was studied during the pyrolysis process in a wide range of operation conditions, i.e., reaction temperature (300-700 °C), residence time (100-190 s) and waste particle size (1-3 cm). Response surface methodology (RSM) and central composite design (CCD) were applied to optimize the operating variables. Cracking and decomposition of feedstock occurred almost optimally in 700 °C resulting in the generation of 73.4% liquid and 24.1% char. The PAHs were characterized in significant concentrations in pyrolytic oil (121-29440 mg/lit) and char (223-1610 mg/kg) products. The formation of total USEPA listed PAH components varied by the operating ranges of temperature, residence time and waste size. In the pyrolytic oil phase, the formation of total PAHs was drastically increased by increasing the waste particle size. It is also found that increasing the temperature and having longer residence times have a high influence on the total 16 USEPA PAHs formation rate in the char phase. It is concluded that fast pyrolysis of hazardous health-care waste, as thermal treatment method, would influence the formation and destruction of PAHs and their fraction to a different extent depending on the role of operating variables.

Proper Health-Care Waste Management (HCWM) and integrated documentation in this sector of hospitals require analyzing massive data collected by hospital\'s health experts. This study presented a quantitative software-based index to assess the HCWM process performance by integrating ontology-based Multi-Criteria Group Decision-Making techniques and fuzzy modeling that were coupled with data mining. This framework represented the Complex Event Processing (CEP) and Corporate Performance Management (CPM) types of Process Mining in which a user-friendly software namely Group Fuzzy Decision-Making (GFDM) was employed for index calculation.
Assessing the governmental hospitals of Shiraz, Iran in 2016 showed that the proposed index was able to determine the waste management condition and clarify the blind spots of HCWM in the hospitals. The index values under 50 were found in some of the hospitals showing poor process performance that should be at the priority of optimization and improvement.
The proposed framework has distinctive features such as modeling the uncertainties (risks) in hospitals\' process assessment and flexibility enabling users to define the intended criteria, stakeholders, and number of hospitals. Having computer-aided approach for decision process also accelerates the index calculation as well as its accuracy which would contribute to more willingness of hospitals\' experts and other end-users to use the index in practice. The methodology could efficiently be employed as a tool for managing hospitals\' event logs and digital documentation in big data environment not only for the health-care waste management, but also in other administrative wards of hospitals.

A study on the generation rate and the composition of solid medical wastes (MW) produced by private medical microbiology laboratories (PMML) was conducted in Greece. The novelty of the work is that no such information exists in the literature for this type of laboratories worldwide. Seven laboratories were selected with capacities that ranged from 8 to 88 examinees per day. The study lasted 6months and daily recording of MW weights was done over 30days during that period. The rates were correlated to the number of examinees, examinations and personnel. Results indicated that on average 35% of the total MW was hazardous (infectious) medical wastes (IFMW). The IFMW generation rates ranged from 11.5 to 32.5g examinee-1 d-1 while an average value from all 7 labs was 19.6±9.6g examinee-1 d-1 or 2.27±1.11g examination-1 d-1. The average urban type medical waste generation rate was 44.2±32.5g examinee-1 d-1. Using basic regression modeling, it was shown that the number of examinees and examinations can be predictors of the IFMW generation, but not of the urban type MW generation. The number of examinations was a better predictor of the MW amounts than the number of examinees. Statistical comparison of the means of the 7PMML was done with standard ANOVA techniques after checking the normality of the data and after doing the appropriate transformations. Based on the results of this work, it is approximated that 580 tonnes of infectious MW are generated annually by the PMML in Greece.

BACKGROUND: Improper treatment of infectious waste can cause numerous adverse environmental and health effects such as transmission of diseases through health personnel and other susceptible groups,who come in contact with such wastes. On the other hand, selection of appropriate treatment alternatives in infectious waste management has become a challenging task for public health authorities especially in developing countries. The objective of this paper is to select the best infectious waste treatment alternative by the modified Sustainability Assessment of Technologies (SAT) methodology, developed by the International Environmental Technology Center of the United Nations Environment Program (IETC-UNEP).
METHODS: SAT methodology consists of three main components, including screening, scoping and detailed assessment. In screening, different infectious waste treatment alternatives undergo screening using the finalized environmental and technical criteria. Short-listed treatment options from the previous step, then go through the comprehensive scoping and detailed assessment (2nd and 3rd components) which is more qualitative and quantitative in nature. An empirical case in Tehran, the largest city in Iran, is provided to illustrate the potential of the proposed methodology.
RESULTS: According to the final score, \"Hydroclave\", was the most suitable infectious treatment technology. The ranking order of the treatment alternatives were \"Autoclave with a shredder\", \"Autoclave\", \"Central Incineration\" and \"chemical treatment\" on the basis of technical, economical, social and environmental aspects and their related criteria.
CONCLUSIONS: According to the results it could be concluded that the top ranking technologies basically have higher scores in all the aspects. Hence it is easier to arrive at a decision for the final technology selection based on the principles of sustainability.