Aim: To evaluate the stages of management of the residues of health services (RSS, acronym in Portuguese) of Group D in a university hospital. Method: This is a field research, of the exploratory and descriptive type, of quantitative-qualitative approach. It uses a validated instrument, the Health-Care Waste Management - Rapid Assessment Tool Brazilian Version (HCWM-RAT Brazilian Version), for data collection in the field. The preparation of the data, statistical and analytical procedures, will be made possible through the software IBM SPSS©. Expected results: Contribute to the implementation and follow-up of the practices recommended by the National Sanitary Surveillance Agency and National Solid Waste Policy; broadening the understanding of the RSS management system; reducing waste management costs; and the reinforcement of the use of scientific evidence in environmental management in the health sector, since it informs and supports the managerial and political decision making.
Descriptors: Public Health; Medical Waste; Environmental Health; Nursing.
Health care waste (SSR) can be defined as the total waste stream that results from human or animal health care, including those generated in the home care system(1-2). Resolution 358/05 of the National Environment Council (Conama) and the Resolution of the Collegiate Board of Directors (RDC, acronym in Portuguese) 306/04 of the National Agency of Sanitary Surveillance (Anvisa) classify them into five groups, namely: Group A, consisting of biological waste; Group B, consisting of chemical residues; Group C, represented by radioactive waste; Group D, consisting of similar to urban solid waste (RSU); and Group E, consisting of sharps.
Recyclable components such as paper/cardboard, plastics and glass represent the highest percentage (80%) in studies carried out in health establishments(1-2), Recyclable components such as paper/cardboard, plastics and glasses represent the highest percentage (80%) in studies carried out in health establishments(1-2); however, when they are not segregated from those classified as biological/infectious, they become contaminated by them and must go to landfills, which represents an unnecessary financial and environmental cost(2), since only the fraction (20%) of the hazardous wastes would be destined to the more secure and costly systems(1-2).
Studies of evaluation of environmental management in the health sector are still incipient in the literature(3), particularly those that use a validated instrument, strengthening the monitoring and evaluation (M&E) mechanism in this specific field.
What is the behavior adopted by managers and professionals of a university hospital regarding the management of health service waste (GRSS, acronym in Portuguese) belonging to Group D?
Evaluate the management stages of the RSS of the Group D in a university hospital.
This is a field research, of the exploratory and descriptive type, of quantitative-qualitative approach. For data collection, a validated and specific instrument for GRSS will be used, the Health-Care Waste Management - Rapid Assessment Tool Brazilian Version.
Instrument
The HCWM-RAT Brazilian Version results from cross-cultural adaptation and questionnaire validation originally developed by the World Health Organization. It is structured in triangulation of methods for data collection(3).
As a modus operandi, the questionnaire has groups of questions (tools A, B, C and D) applicable to specific individuals. Tool A is aimed at agents of non-governmental organizations, tool B should be applied to representatives of the Ministry of Health and Environment, and tool C should be applied to representatives of the municipal body(2).
The tool D, local level (health establishments), is subdivided into four subgroups of questions, D1, D2, D3 and D4, and should be applied to representatives of the hospital administration, head of nursing, GRSS responsible and general service professionals, respectively(2). In this study, only D-tool questions will be applied.
Scenario
This research is based on a university hospital in the metropolitan region of the state of Rio de Janeiro. According to the National Registry of Health Establishments (CNES), this hospital has 1,765 professionals distributed in activities for basic, medium and high complexity care. Its area of coverage reaches an estimated population of more than two million inhabitants; and it generates biological, chemical, radioactive and similar residues to MSW.
Participants
The sample will be for convenience. It will be scaled according to the modus operandi of tool D and hospital organization. That is, the questions of tool D (subgroups, D1, D2, D3 and D4) should be answered by individuals/representatives of sectors of the hospital. Eligibility criteria for determination of respondents: director/administrator of the hospital, to whom the tool-D1 is addressed; chief nurses and/or the Hospital Infection Control Committee (HICC), respondents of the D2 tool; responsible managers or partners or committee participants for GRSS, for which the D3 tool will be applied; and, collecting/transporting workers from RSS, tool-D4 respondents. Those that do not meet the eligibility criteria or that are not available during data collection will be excluded.
Data analysis
Data preparation, statistical and analytical procedures will be enabled by the use of the software Statistical Package for Social Sciences © version 20.0.
Ethical aspects
According to the Resolution of the National Health Council No. 466/2012, the study was approved by the Research Ethics Committee of the hospital study scenario, under Opinion No. 1,608,748.
Contribute to the implementation and follow-up of the practices recommended by Anvisa and the National Solid Waste Policy (PNRS); broadening the understanding of the RSS management system; reduction of waste management costs; and, the reinforcement of the use of scientific evidence in environmental management in the health sector, since it informs and supports the managerial and political decision making.
Chartier Y, Emmanuel J, Pieper U, Prüss A, Rushbrook P, Stringer R, et al. Safe management of wastes from health-care activities: a practical guide. 2nd ed. Geneva: WHO [Internet]. 2014 [Cited 2016 03 Mai]. Available from: http://www.searo.who.int/srilanka/documents/safe_management_of_wastes_from_healthcare_activities.pdf?ua=1.
Silva ENC. Gerenciamento de resíduos de serviços de saúde: adaptação transcultural e validação do instrumento healt-care waste management –rapid assessment tool’ para a língua portuguesa no Brasil. Tese [Doutorado em Saúde Pública e Meio Ambiente]. Rio de Janeiro (RJ): Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz; 2011.
Cozendey-Silva EN, Silva CR, Larentis AL, Wasserman JC, Rozemberg B, Teixeira LR. Cross-cultural adaptation of an environmental health measurement instrument: Brazilian version of the health-care waste management • rapid assessment tool. BMC Public Health [Internet]. 2016 [Cited 2016 10 Oct]; 16:928. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5011988/pdf/12889_2016_Article_3618.pdf. DOI 10.1186/s12889-016-3618-4
All authors participated in the phases of this publication in one or more of the following steps, in according to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the version submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf
Received: 07/12/2017 Revised: 09/20/2018 Approved: 09/24/2018