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RESUMO Objetivo: avaliar a geração e o gerenciamento de resíduos de serviços de saúde (RSS) nos serviços inseridos na atenção básica à saúde. Método: estudo descritivo e de abordagem quantitativa. Esta pesquisa foi realizada com os responsáveis pelo gerenciamento de RSS de 27 estabelecimentos de saúde. Os dados foram coletados por meio de questionários autorrespondidos e pesagem dos RSS e foram analisados por meio da estatística descritiva. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa da Universidade Federal de São Carlos - UFSCar. Resultados: os 27 estabelecimentos de saúde geraram 719,665 kg de RSS, sendo 300,140 kg de RSS gerados pelas Equipes de Saúde da Família (EqSF) e 419,525 kg de RSS oriundos das Unidades Básicas de Saúde (UBS). Destaca-se que 66,6% (14) dos participantes de EqSF não souberam descrever como era realizada a segregação dos resíduos químicos; e 50,0% (6) dos respondentes de UBS não souberam informar o tipo de disposição final oferecida aos RSS. Conclusão: a elevada geração de RSS e as lacunas apresentadas no gerenciamento podem ser minimizadas por meio da implementação de medidas que visem à capacitação dos responsáveis pelo manejo e trabalhadores dos serviços de saúde, além da implantação da coleta seletiva a fim de contribuir para um desenvolvimento sustentável.

RESUMEN Objetivo: evaluar la generación y gestión de residuos de servicios de salud (RSS) en servicios incluidos en la atención primaria de salud. Método: estudio descriptivo con enfoque cuantitativo. Esta encuesta se realizó con los responsables de la gestión del RSS de 27 establecimientos de salud. Los datos fueron recolectados a través de cuestionarios auto respondidos y pesaje RSS y fueron analizados usando estadística descriptiva. La investigación fue aprobada por el Comité de Ética en Investigación de Universidade Federal de São Carlos - UFSCar. Resultados: los 27 establecimientos de salud generaron 719.665 kg de RSS, con 300.140 kg de RSS generados por los Equipos de Salud de la Familia (EqSF) y 419.525 kg de RSS de las Unidades Básicas de Salud (UBS). Cabe señalar que el 66,6% (14) de los participantes de EqSF no pudieron describir cómo se realizó la segregación de desechos químicos; y el 50,0% (6) de los encuestados de UBS no pudieron informar el tipo de disposición final ofrecida al RSS. Conclusión: la alta generación de RSS y las brechas en la gestión se pueden minimizar mediante la implementación de medidas dirigidas a capacitar a los responsables de la gerencia y trabajadores de los servicios de salud, además de la implementación de la recolección selectiva con el fin de contribuir al desarrollo sustentable.

ABSTRACT Objective: to assess the generation and management of waste from health services (WHS) in the services included in Primary Health Care. Method: a descriptive study with a quantitative approach. This research was conducted with the people in charge of managing WHS from 27 health care facilities. The data were collected by means of self-administered questionnaires, as well as the WHS weigh, and were analyzed through descriptive statistics. The research was approved by UFSCar's Research Ethics Committee. Results: the 27 health care facilities generated 719.665 kg of WHS, with 300.140 kg generated by the Family Health teams (FHts) and 419.525 kg by the Basic Health Units (BHUs). It is noteworthy that 66.6% (14) of the FHt participants were unable to describe how the chemical waste was segregated; and that 50.0% (6) of the BHU respondents were unable to report the type of final disposal for the WHS. Conclusion: the high generation of WHS and the gaps presented in management can be minimized through the implementation of measures aimed at training those responsible for the management and the health care workers, in addition to the implementation of selective collection in order to contribute to sustainable development.

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Hospital functioning generates a great quantity of contaminants, among which organic materials, heavy metals, and diverse pharmaceuticals are noteworthy that can affect organisms if they are not properly removed from the effluents. The hospital effluent evaluated in the present study came from IMSS (Instituto Mexicano del Seguro Social) Clinic 221 in downtown Toluca, State of Mexico, a secondary care facility. The contaminants identified in hospitals have been associated with deleterious effects on aquatic organisms; however, it is necessary to continue with more studies in order to be able to regulate the production of said contaminants which are generally dumped into the city sewage system. The present study had the purpose of evaluating the alterations to embryonic development and teratogenic effects on oocytes Cyprinus carpio after exposure to different proportions of hospital effluent. For said purpose, the physicochemical properties of the effluent were determined. Concentrations of the main microcontaminants were also determined. An embryolethality study out and the determination of the main alterations to embryonic development and teratogenic effects produced, due to exposure of C. carpio at different proportions of the effluent, were carried out. The results showed that the physicochemical properties were within the values permitted by Mexican regulation; however, the presence of contaminants such as NaClO, metals, anti-biotics, anti-diabetics, non-steroidal anti-inflammatory drugs, hormones and beta-blockers, was detected. Lethal concentration 50 was 5.65% and the effective concentration for malformations was 3.85%, with a teratogenic index of 1.46. The main teratogenic alterations were yolk deformation, scoliosis, modified chorda structure, tail malformation, fin deformity and mouth hyperplasia. A high rate of hatching delay was observed. The results suggest that the hospital effluent under study is capable of inducing embryotoxicity and teratogenicity in oocytes of C. carpio.

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Objective: to identify the medical waste generation rates (kg.bed-1.day-1) for the waste groups A, B, D (including recyclables) and E, and to verify seasonal influence in the generation of waste. Methods: Data were collected by weighing the waste, during seven consecutive days for four weeks, with each week correspondingto a season. Results: The waste generation rate presented the following values in kg.bed-1.day-1 for each group: A: 0.831, B: 0.088, D: 2,607, D-Recyclable: 0.525 and E: 0.102. Based on the analysis of variance (ANOVA) test, it was not found evidence that seasonality influences with the generation of the waste. Conclusion: Hospitals with similar numbers of beds have divergent values for the waste generation rates, therefore it was not possible to use a reference rate for comparison with other hospitals. Finally, the ANOVA test did not found evidence that seasonality influences the generation of the waste.

Objetivo: identificar as taxas de geração de resíduos do serviço de saúde (kg.leito-1.dia-1) para os grupos de resíduos A, B, D (incluindo os recicláveis) e E verificar a influência da sazonalidade na geração de resíduos. Métodos: Os dados foram coletados através de pesagens desses resíduos, durante sete dias consecutivos, em quatro semanas, sendo que cada semana contemplou uma estação do ano. Resultados: A taxa de geração de resíduos apresentou os seguintes valores em kg.leito-1.dia-1 para cada grupo: A: 0,831, B: 0,088, D:2,607, D-Recicláveis: 0,525 e E: 0,102. Através do teste ANOVA não foram encontradas evidências de que haja influência da sazonalidade na geração dos resíduos. Conclusão: Hospitais com número de leitos semelhantes apresentam taxas de geração de resíduos diferentes, portanto não foi possível utilizar uma taxa de geração de referência para comparação com outros hospitais. Ainda, o teste ANOVA não indicou que a sazonalidade influencia a geração de resíduos.

Objetivo: identificar las tasas de generación de desechos en los Servicios de Salud (kg.lecho-1.día-1) para los grupos A, B, D (incluyendo materiales reciclables) y E, y comprobar la influencia de la estacionalidad en la generación de desechos. Método: Los datos fueron colectados mediante el pesaje de los desechos, durante siete días consecutivos durante cuatro semanas, con cada semana a corresponder a una temporada. Resultados: La tasa de generación de desechos presentan los siguientes valores en kg.lecho-1.día-1 para cada grupo: A: 0,831, B: 0,088, D: 2607, D-Reciclable: 0.525 y E: 0.102. Con base en el análisis de varianza (ANOVA), no fueron encontradas evidencias de influencia de la estacionalidad en la generación de los desechos. Conclusión: Los hospitales con un número similar de lechos tienen tasas de generación de desechos divergentes, por lo queno fue posible utilizar un valor de referencia para la comparación con otros hospitales. Finalmente, el ANOVA no encontró evidencia de que la estacionalidad influye en la generación de los residuos.

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BACKGROUND: Blood is a valuable resource and blood wastage in a low socio economic country could impose a very serious impact on healthcare. This study therefore analyzes the usage and wastage of blood and blood products at the Georgetown Public Hospital Cooperation (GPHC), Guyana. METHODS: A retrospective study was conducted on the data retrieved from laboratory blood banking information system on usage and wastage of blood products during the years 2012-2014 at the public hospital. The data were analyzed in MS Excel and SPSS 20.0. RESULTS: A total of 16,426 units of blood were issued from National Blood Transfusion Services. During the study period the most frequently requested blood component was packed cells followed by fresh frozen plasma (FFP), platelet, cryoprecipitate (CRYO) and whole blood respectively. Data indicated that 4167 units (25 %) of blood were wasted due to various reasons at GPHC. CONCLUSIONS: There is a need for intervention through raising awareness among medical staff in reducing blood wastage.

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OBJECTIVES: to evaluate the heterogeneity of biomedical waste (BW) using Nightingale charts. METHOD: cross-sectional study consisting of data collection on wastes (direct observation of receptacles, physical characterisation, and gravimetric composition), development of a Management Information System, and creation of statistical charts. RESULTS: the wastes with the greatest degree of heterogeneity are, in order, recyclable, infectious, and organic wastes; chemical waste had the most efficient segregation; Nightingale charts are useful for quick visualisation and systematisation of information on heterogeneity. CONCLUSION: the development of a management information system and the use of Nightingale charts allows for the identification and correction of errors in waste segregation, which increase health risks and contamination by infectious and chemical wastes and reduce the sale and profit from recyclables.

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OBJECTIVE: to analyze waste management in urgency and emergency non-hospital health care service units. METHOD: Epidemiological cross-sectional study undertaken at three Non-Hospital Emergency Units. The data were collected using systematic observation, registered daily in a spreadsheet and checklist, and analyzed through descriptive statistics. RESULTS: the generation of waste varied from 0.087 to 0.138 kg per patient per day. Waste management showed inadequacies in all stages, especially in the separation stage. Infectious waste was found together with common waste, preventing recycling, and piercing and cutting objects were mixed with waste from different groups, increasing the risk of occupational accidents. CONCLUSION: the study reveals the lack of an institutional waste management policy, as demonstrated by the failure of operational stages, involving problems related to management, physical structure, material and human resources at the units. This is relevant for health care units, considering the quality of patient care and its interface with sustainability.

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OBJECTIVE: to analyze waste management in urgency and emergency non-hospital health care service units. METHOD: Epidemiological cross-sectional study undertaken at three Non-Hospital Emergency Units. The data were collected using systematic observation, registered daily in a spreadsheet and checklist, and analyzed through descriptive statistics. RESULTS: the generation of waste varied from 0.087 to 0.138 kg per patient per day. Waste management showed inadequacies in all stages, especially in the separation stage. Infectious waste was found together with common waste, preventing recycling, and piercing and cutting objects were mixed with waste from different groups, increasing the risk of occupational accidents. CONCLUSION: the study reveals the lack of an institutional waste management policy, as demonstrated by the failure of operational stages, involving problems related to management, physical structure, material and human resources at the units. This is relevant for health care units, considering the quality of patient care and its interface with sustainability.

OBJETIVO: analisar o gerenciamento de resíduos nos serviços de saúde, em unidades não hospitalares de atendimento às urgências e emergências. MÉTODO: estudo epidemiológico, transversal, realizado em três unidades não hospitalares de atendimento às urgências e emergências. Os dados foram coletados por meio de observação sistematizada e registrados diariamente em planilha e checklist e analisados por meio de estatística descritiva. RESULTADOS: a geração de resíduos variou de 0,087 a 0,138kg/usuário/dia. O manejo de resíduos apontou inadequações em todas as etapas, principalmente na segregação. Encontraram-se resíduos infectantes adicionados aos comuns, inviabilizando a reciclagem, bem como perfurocortantes misturados aos diferentes grupos, aumentando o risco de acidente ocupacional. CONCLUSÃO: o estudo revela a inexistência de política institucional de gerenciamento de resíduos, evidenciada por falhas nas etapas operacionais que envolvem problemas de gestão, estrutura física, recursos materiais e humanos das unidades. Apresenta relevância para os estabelecimentos de saúde no que tange à qualidade do atendimento ao usuário e à sua interface com a sustentabilidade.

OBJETIVO: analizar la gestión de los residuos en unidades hospitalarias de emergencias y urgencias. MÉTODO: estudio epidemiológico. Los datos fueron recolectados por observación sistemática, registrados diariamente en una hoja de cálculo y check list y analizados mediante estadística descriptiva. RESULTADOS: la generación de residuos varió desde 0,087 hasta 0,138 kg / usuario / día. La gestión de los residuos mostró deficiencias en todas las etapas, especialmente en la segregación. Fueron encontrados residuos infecciosos añadidos a los comunes, invalidando el reciclaje, así como materiales punzantes y cortantes mezclados con los diferentes grupos, amentando el riesgo de accidentes de trabajo. CONCLUSIÓN: el estudio revela la ausencia de una política institucional para la gestión de los residuos, como lo demuestran las fallas en las medidas operacionales, que implican problemas de gestión, estructura física, recursos materiales y humanos de las unidades. Muestra relevancia para los servicios de salud en lo que se refiere a la calidad del servicio para el usuario y su interfaz con la sostenibilidad.

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OBJECTIVE: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes. MATERIAL AND METHODS: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (i.v.) tubes, and d) for intramuscular (i.m.), subcutaneous (s.c.), or intradermic (ID) injections. RESULTS: A total of 7,157 plastic disposable syringes was used; 1,227 (17%) contained blood during use, 346 (4.8%), other body fluids, 5,257 (73%) were used exclusively for drug dilution and application in plastic i.v. lines, and 327 (4.5%) were utilized for i.m., s.c., or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law. CONCLUSIONS: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage. The English version of this paper is available too at: http://www.insp.mx/salud/index.html.

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OBJECTIVE: To determine amount of syringes used in the hospital and extent of contact with blood and body fluids of these syringes. MATERIAL AND METHODS: Syringe use was surveyed at a tertiary care center for one week; syringes were classified into the following four categories according to use: a) contained blood; b) contained other body fluids (urine, gastric secretion, cerebrospinal fluid, wound drainage); c) used exclusively for drug dilution and application in plastic intravenous (IV) tubes, and d) for intramuscular (IM), subcutaneous (SC), or intradermic (ID) injections. RESULTS: A total of 7 157 plastic disposable syringes was used; 1 227 (17 percent) contained blood during use, 346 (4.8 percent), other body fluids, 5 257 (73 percent) were used exclusively for drug dilution and application in plastic IV lines, and 327 (4.5 percent) were utilized for IM, SC, or ID injections. An estimated 369 140 syringes used annually, or eight syringes per patient per in-hospital day. All syringes were disposed of as regulated medical waste, in observance of the law. CONCLUSIONS: There is an urgent need to review recommendations for medical waste management by both international agencies and local governments, based on scientific data and a cost-benefit analysis, to prevent resource waste and further environmental damage

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