Environmental and Health Risks Associated with Biomedical Waste: A Case of University Teaching Hospital of Butare, Huye, Rwanda

This study investigated the environmental and health risks associated with biomedical waste in CHUB, Huye District, Rwanda. In the majority of countries across the world, the preservation of the environment and public health depends on the proper biomedical waste collection and disposal. It has been reported that the management of biomedical wastes results in needless deaths of individuals each year. The study had four objectives: (1) To assess the biomedical waste generation and disposal practices across all departments at CHUB;(2) To investigate the implementation and enforcement of biomedical waste management regulations ;(3) To assess the risks related to biomedical waste to humans and the environment.; and (4) To find out the level of knowledge among healthcare workers on biomedical waste management. With a cross-sectional study design survey and observation methods, data were collected from clinical service of inpatient departments, and the study population was 196 health workers. The WHO rapid assessment tool for waste management and water sanitation was adapted and used. The results of this study showed a great amount of biomedical waste are well segregated (92%), and color coding is respected during biomedical wastes collection and disposal (100%) but a significant part of biomedical liquid wastes are disposed of directly to hand-wash sink water evacuation (14%). Significant cases of needle stick injuries were also observed (21%) and internal regulations and protocols on biomedical waste management are available in most clinical services. The study recommends that regular training of health professionals in biomedical waste management, including transport and disposal essentials, connect remaining clinical departments to the specialized pit dedicated to biomedical liquid wastes to avoid any risk of direct contamination or environmental contamination; and documentation on the type of biomedical waste generated in all clinical services is an important point to be improved. Keywords: Biomedical wastes, Environmental risk, Waste segregation, Color-coding System, Infection Prevention Control, Environmental risks, University Teaching Hospital of Butar

Analyse des effets de la pratique de l'évaluation d'impact sur la santé

Introduction : L’environnement urbain est un déterminant important de la santé et l’évaluation d’impact sur la santé se présente comme un moyen de bonifier les projets locaux, notamment les projets de revitalisation ou de réaménagement urbain. Devant l’importance des enjeux financiers de ce type de projets et considérant la nécessité de revoir l’organisation de nos villes et villages centrée sur la santé, il devient important de se questionner sur les effets de cette approche. Objectif : L’objectif est d’analyser les effets de l’évaluation d’impact sur la santé dans le cadre du projet de revitalisation du Vieux-Sorel. Cette recherche vise : 1) à analyser le potentiel de cette approche sur la prise de décision ; 2) à explorer le lien entre les actions envisagées et les résultats en matière de santé ; 3) à analyser les effets en lien avec le fait de ne pas prendre en considération l’équité lors de l’ÉIS. Méthodologie : Pour l’analyse les effets, nous avons utilisé un devis d’analyse de la contribution qui est une approche évaluative axée sur la théorie de l’intervention (Mayne, 2012). Notre analyse repose ainsi sur différentes sources de données, soit : une analyse documentaire, des entrevues individuelles semi-structurées, un groupe de discussion, des images et observations sur le terrain. L’équité n’ayant pas été prise en considération dans l’ÉIS et pour apprécier les effets sur cette dimension, nous avons privilégié une analyse qualitative descriptive. Résultat : Le premier article, méthodologique, présente notre démarche d’analyse des effets de la pratique d’évaluation d’impact sur la santé. Le deuxième article présente nos principaux résultats de l’analyse des effets de l’ÉIS sur la prise de décision et la santé. Cet article souligne que la pratique d’ÉIS a contribué à la prise de décision en rapport à la rénovation des infrastructures routières et le réaménagement des parcs et espaces verts urbains. Elle n’a toutefois pas entrainé des changements favorables à la santé en lien avec la rénovation du parc de logements résidentiels. L’étude montre que cette pratique agit en synergie avec les facteurs contextuels et les autres approches utilisées pour bonifier les actions publiques au niveau municipal. Enfin, l’étude met en évidence que l’ÉIS a favorisée un environnement bâti propice à l’activité physique ; cela pourrait avoir un impact sur la réduction des maladies liées à l’obésité. Les résultats du troisième article indiquent que conduire une ÉIS sans intégrer les impacts sur l’équité comporte des risques. Nos résultats insistent sur l’importance de considérer : 1) les impacts potentiels des autres actions qui ont lieu dans la même zone, 2) le besoin d’évaluer les impacts potentiels sur les iniquités et 3) la nécessité d’évaluer si les recommandations liées à l’ÉIS n’entraînent pas le risque d’augmenter les iniquités. L’étude propose également des solutions permettant d’anticiper et d’atténuer les conséquences potentielles de la revitalisation du centre-ville sur les iniquités pour les populations les plus vulnérables. Conclusion : Cette thèse apporte une meilleure compréhension de l’effet de la pratique d’ÉIS au niveau municipal et elle informe sur les pratiques à instaurer pour s’assurer que l’ÉIS conduise à améliorer la santé et l’équité au sein de la population

Short‐Term Impact of Traffic‐Related Particulate Matter and Noise Exposure on Cardiac Function

Exposure to traffic-related air pollution and noise exposure contributes to detrimental effects on cardiac function, but the underlying short-term effects related to their simultaneous personal exposure remain uncertain. The aim is to assess the impact of total inhaled dose of particulate matter and total noise exposure on the variations of electrocardiogram (ECG) parameters between pre-cycling and post-cycling periods. Mid-June 2019, we collected four participants’ personal exposure data related to traffic-related noise and particulate matter (PM2.5 and PM10) as well as ECG parameters. Several Bayesian linear models were built to examine a potential association between air pollutants and noise exposure and ECG parameters: heart rate (HR), standard deviation of the normal-to-normal intervals (SDNN), percentage of successive RR intervals that differ by more than 50 ms (pNN50), root mean square of successive RR interval differences (rMSSD), low-frequency power (LF), high-frequency power (HF), and ratio of low- to high-frequency power (LF/HF). We analyzed in total 255 5-min segments of RR intervals. We observed that per 1 µg increase in cumulative inhaled dose of PM2.5 was associated with 0.48 (95% CI: 0.22; 15.61) increase in variation of the heart rate, while one percent of total noise dose was associated with 0.49 (95% CI: 0.17; 0.83) increase in variation of heart rate between corresponding periods. Personal noise exposure was no longer significant once the PM2.5 was introduced in the whole model, whilst coefficients of the latter that were significant previously remained unchanged. Short-term exposure to traffic-related air and noise pollution did not, however, have an impact on heart rate variability

Quantities and qualities of fecal sludge : experiences from field implementation with a Volaser in 7 countries during a pandemic

Reasonable estimates for quantities and qualities (Q&Q) of fecal sludge that accumulate in onsite sanitation containments are fundamental for the design of appropriate management and treatment solutions, from community to city-scale. There are increasing attempts to improve Q&Q estimates, but current approaches are still at a conceptual level, and are not yet standardized with confirmed statistical relationships. To reach this level, we will need consistent approaches for planning, measuring, and global collaborations. Hence, the objectives of this study were: (1) to assess and compare Q&Q of fecal sludge from seven cities and communities, and explore statistical relationships that could be used to increase accuracy of Q&Q estimations; (2) to test and launch the Volaser device for measuring in situ volumes of fecal sludge; and (3) to capture lessons learned from field implementation with collaborators in seven countries during a global pandemic when no international travel was possible. The study took place in Ghana, India, Lebanon, Kenya, Sierra Leone, Uganda, and Zambia during the COVID-19 pandemic. Q&Qs were measured in 204 containments with a Volaser, laboratory analysis, and questionnaire. Results indicate that there are differences in Total Solids (TS) and Chemical Oxygen Demand (COD) in fecal sludge based on containment type, toilet type, source, and whether there is a water connection on the premises. Based on the results of this study, together with previously published open-source data, an empirical relationship for Volatile Solids (VS) and TS of 0.49 (R2 = 0.88) was established using 1,206 data points. For COD/TS, no significant relationship was observed. Developing such empirical relationships will be useful for planning and modeling approaches. An external evaluation was conducted to evaluate overall project management, Volaser technology transfer, and effects of collaborating during the COVID-19 pandemic. Success factors for collaborating with new and existing partners without face-to-face meetings included laboratory capacity and experience with analytical methods, study objectives that were relevant for the partner and locality, and a strong quality assurance plan to ensure comparability of results. The lessons learned can be taken forward as ways to reduce carbon footprint, and contribute to resilient, inclusive development research projects

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Abstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Language endangerment and language documentation in Africa

Non peer reviewe

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake