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Heliyon 10 (2024) e31814
Available online 24 May 2024
2405-8440/© 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC license
(http://creativecommons.org/licenses/by-nc/4.0/).
Research article
Generation rate of hospital solid waste from different services: A
case study in the province of Bagua, northern Peru
Juan Eduardo Suarez Rivadeneira
a
,
*
, Eduardo Benjamín Suarez Chavarry
b
, ´
Italo
Maldonado Ramirez
c
, Wilfredo Ruiz Camacho
d
, Edilbrando Vega Calder´
on
e
,
Roberto P´
erez Astonitas
f
, Roberto Carlos Santa Cruz Acosta
g
, Morales-Rojas Eli
a
,
h
,
Heling Kristtel Masgo Ventura
i
, Mayra Pamela Musay´
on Díaz
j
a
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Jr. Atahualpa Nº 1300,
Bagua, Amazonas, Peru
b
Universidad Nacional Pedro Ruiz Gallo, Calle Juan XXIII 391, Lambayeque, Peru
c
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Jr. 1ero de Setiembre
N◦400, Bagua, Amazonas, Peru
d
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Jr. Sargento Lores
N◦439, Bagua, Amazonas, Peru
e
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Calle los Tamarindos
Centenario Casa Blanca Mz 7 k3 Lote N◦3, Chiclayo, Lambayeque, Peru
f
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Av. Ferdando Belaunde
Terry Mz 6 Lote 30, Chiclayo, Lambayeque, Peru
g
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Calle Agropecuaria
N◦520, Bagua, Amazonas, Peru
h
Universidad Nacional Intercultural Fabiola Salazar Leguía de Bagua. Innovaci´
on y Transferencia Tecnol´
ogica, Calle Agropecuaria N◦520, Bagua,
Amazonas, Peru
i
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Av. H´
eroes del Cenepa
1118, Bagua, Amazonas, Peru
j
Facultad de Ingeniería y Sistemas y Mec´
anica El´
ectrica, Universidad Nacional Toribio Rodríguez de Mendoza de Amazonas, Jr. El Comercio N◦365,
Bagua, Amazonas, Peru
ARTICLE INFO
Keywords:
Medical services
Biocontaminated waste
Hospital
Bagua
ABSTRACT
The objective of this research was to evaluate the unit generation rate of solid hospital waste at
the Gustavo Lanatta Lujan Bagua Support Hospital (HAB). The calculations were based on the
weights of hospital waste disposed periodically to the biosafety cell located 7 km from the city of
Bagua since 2015. Nineteen services were identied and grouped into three areas: hospitalization
area, emergency area and gynecology area, studied according to the group classication of
Peruvian regulations. The results show that 92.77 kg/day-1 are generated, 62.26 % are bio-
contaminated waste, 26.45 % are common waste, 7.7 % are sharp-sharp waste and 3.6 % are
special waste. It was also found that only 73.56 % is disposed of in the hospital’s biosafety cell. In
this sense, this study will contribute to promote the reduction of the entry of hazardous sub-
stances into the stream of an adequate waste management and save workers and the environment
* Corresponding author.
E-mail addresses: juan.suarez@untrm.edu.pe (J.E. Suarez Rivadeneira), pepito_9023@hotmail.com (E.B. Suarez Chavarry), Italo.Maldonado@
untrm.edu.pe (´
I.M. Ramirez), Wilfredo.ruiz@untrm.edu.pe (W.R. Camacho), edilbrando.vega@untrm.edu.pe (E.V. Calder´
on), roberto.perez@
untrm.edu.pe (R.P. Astonitas), roberto.santacruz@untrm.edu.pe (R.C.S.C. Acosta), eli.morales@untrm.edu.pe (M.-R. Eli), kristtel.masgo@untrm.
edu.pe (H.K.M. Ventura), mayra.musayon@untrm.edu.pe (M.P. Musay´
on Díaz).
Contents lists available at ScienceDirect
Heliyon
journal homepage: www.cell.com/heliyon
https://doi.org/10.1016/j.heliyon.2024.e31814
Received 8 March 2024; Received in revised form 2 May 2024; Accepted 22 May 2024
Heliyon 10 (2024) e31814
2
in the Amazon Region. Therefore, awareness should be raised at all levels of society through
various means of communication and education, so that the risks of spreading health hazards can
be minimized by improving hospital waste management. In addition, healthcare waste man-
agement should be implemented, taking into account the parameters to be monitored, the eco-
nomic resources to be managed and the national plans for healthcare waste.
1. Introduction
Hospital waste is a worldwide concern about negative impacts, especially in developing countries [1]. During the development of
their activities, and industrial health facilities generate waste that present potential hazardous risks, and inadequate management
entails serious consequences for the health of the hospital community, the personnel in charge of external waste management, and the
population [2,3]. Globally, it is estimated that about 85 % are common wastes and the remaining 15 % are hazardous, infectious and
toxic wastes [4], their dangerousness lies in the possibility of favoring the transmission of diseases such as AIDS, hepatitis B and C and
several resistant bacterial infections [5]. In this line are sharps waste, caused by infectious waste generated in health facilities, In this
line are sharps waste, caused by infectious waste generated in healthcare facilities, these results can threaten urban as well as rural
areas, and the environmental and social impact worsens as the world’s population increases [6,7].
In European Union countries there is signicant variation, dened as waste from human or ani-mal health care and/or related
research [8], and there is concern about the impact on public health [9]. Health facilities are responsible for reducing and preventing
the health problems of the population [10], given that hospital waste can vary signicantly between countries in Latin America and the
Caribbean, the European Union [11], and the different varieties of waste generated in health facilities are considered hazardous waste
by the Basel Convention and have been classied with the acronym Y1 - Clinical waste resulting from medical care provided in
hospitals, medical centers and clinics [12]. Therefore, these wastes must be properly managed and their mismanagement is a problem
in most countries and especially in developing countries [13].
It has been observed in several studies that solid waste from health care facilities for general and hazardous waste varies within a
country [14]. Solid waste management, particularly medical solid waste, is emerging as a major problem. The amount of solid waste
generated by 1 in 3 health care facilities does not safely manage medical waste, and 3 in 10 health care facilities lack systems to
segregate waste globally [15]. In Uganda, they quantied and characterized the general waste management patterns at the Mula-
godonde referral hospital and found that the average solid waste generation rate was 111.4 kg per day and the wards produced the
largest amounts, followed by the operating rooms, kitchen, public areas, laundry and administration. Therefore, pre-treatment systems
should be implemented [16]. In the district of Sheikhupura, Pakistan, ve public hospitals were evaluated, as a result of which it
became evident that by applying an integrated approach, it would be possible to mitigate GHG emissions by 37,756.44 kg CO
2
-eq. per
ton of waste annually [17].
In Latin America and the Caribbean, the management of biocontaminated waste is still in its infancy, where the presence of various
health determinants and educational factors deteriorate the health of the population [18]. Therefore, it is necessary that health
workers involved in its management understand the integral link between human health and environmental health [19].
Peru is no stranger to the problems of waste management in many hospitals, which is very decient. Most of the biomedical waste
produced is not adequately treated [20]. The average production of biocontaminated waste from health facilities at the national level
ranges between 0.15 and 840 kg/day, depending on the grade and category. National health facilities administered by MINSA generate
approximately 67,000 kg/day [21] and these are in the non-municipal management area [22]. It is important to mention that
approximately 20,000 tons of biocontaminated waste are generated per year, 75 % in Lima and the remaining 25 % in the provinces
[23]. Studies related to hospital waste management in Peru are still lacking. Likewise, the hospital waste disposal and treatment system
and public statistics are very limited, which limits its proper management [24]. Therefore, policy makers should formulate policies for
the development of comprehensive waste management databases to effectively develop the necessary policies [25], as well as the
implementation of new management techniques instead of building new facilities [26].
Hospital waste is classied into three groups, according to their characteristics. Group A includes biocontaminated waste; in group
B, special waste; in group C, common waste [22]. This classication is essential for the hospital solid waste management system to be
effective in controlling health risks. Where group A is the hazardous waste generated in the process of medical care that is contam-
inated with infectious agents, with a high content of microorganisms of high risk for the person who comes into contact with such
waste. Group B is hazardous waste, with physical and chemical characteristics of potential danger due to its corrosive, ammable,
toxic, explosive and reactive properties for the exposed person. Group C includes waste generated in the administration, waste from the
cleaning of gardens, yards, public areas, remains from food preparation, etc., as well as waste from the cleaning of the public areas In
this sense, it is important to manage it from containment, storage and nal disposal according to the Hospital Waste Management
Standard [27], incorporating the commitment and active participation of all hospital personnel [28].
Therefore, appropriate waste management strategies should be formulated [29]. Health facilities should comply with certain
management measures, such as the formation of the Integrated Management and Solid Waste Management Committee, and have a Plan
or Program for Minimization and Management of Non-municipal Solid Waste.
Based on the above, the objective of this research was to evaluate the unit generation rate of hospital waste at the Gustavo La-Natta
Lujan hospital.
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
3
2. Materials and methods
Description of the study areaThe province of Bagua is geographically located at 05◦38
′
21
″
south latitude and 78◦31
′
54
″
west longitude
(Fig. 1). It is located in the northern jungle of Peru, at an altitude of 420 m above sea level [30]. It has an approximate population of 74,
100 inhabitants [31]. It has an average annual accumulated precipitation of 1832 mm and an annual air temperature of 30 ◦C [32], and
is characterized by a very warm climate. Favorable climate for metaxenic diseases such as dengue caused by mosquito bites [33].
The Bagua biosafety cell for hospital waste has an airtight design and has been in operation since 2015. In addition, its resistance is
210 kg/cm
3
and it is waterproofed with Sika®-1 additive. Its integrated decontamination system uses 02 bags of lime and 02 bags of
soil for each nal disposal to guarantee the complete elimination of pathogens (Fig. 2A). In addition, the personnel responsible for the
disposal of hospital waste have all the clothing (overalls, safety glasses, steel-toed boots, leather gloves), in accordance with the
regulations in force by the Health sector [22].
The area is 2 ha and was donated by the Regional Government of Amazonas. It is located 7 km from the city of Bagua, its dimensions
are 8.00 m ×4.00 m x 3.50 m (112 m
3
) and its nal disposal accepts all types of hospital waste (Biocontaminated and special) (Fig. 2).
The hospital waste from the 19 services was grouped in 03 areas, and the transfer was done using an exclusive-use (Fig. 2B), totally
enclosed truck with a capacity of 6 m
3
owned by the institution; the frequency of waste removal to the biosafety cell is twice a week.
The average daily rate of hospital waste generation is 92.77 kg/day.
The Gustavo Lanatta Lujan hospital is public and its category is II - 1, and for a better attention it offers services that were grouped
in 03 areas: (i) hospitalization area, (ii) emergency area, and (iii) gynecology area, being the only referential hospital located in the
area and that allows attending the provinces of Condorcanqui, Utcubamba and the district of Santa Rosa - Province of Jaen.
2.1. Data collection and grouping
Hospital waste data collected through eld notebooks expressed in kg/day and m
3
/day by type of solid waste (bioconta-mined,
common, sharps and special), the collection was from April 26 to May 02, 2023. Data from nineteen (19) services were used in this
work with a total of 123 beds, of which seven (07) services are in the hospitalization area with 59 beds, three (03) services are in the
emergency area with 21 beds and nine (09) services are in the gynecology area with 43 beds (Table 1). All data collection was carried
out taking into account the “Technical Health Standard: Integral management and handling of solid waste in health facilities, medical
support services and research centers".
The volume of hospital waste was designed according to the capacity of the container (200 L cylinder), with the amount generated
Fig. 1. Location map of the province of Bagua.
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
4
in the day [22,34] (Equation (1)).
Volume of hospital waste =
π
D
22
xHf−Ho(1)
π
=constant (3.1416); Hf=Total cylinder height; Ho =Cylinder free height; D =Cylinder diameter.
Likewise, the 19 services used in this study were also grouped into three (03) areas that dispose biocontaminated waste (Group A, A
- 5) and special waste (Group B) and group C, as established by Peruvian regulations (since both groups are disposed of in the biosafety
cell).
2.2. Statistical analysis
Statistical analysis of the data was performed for each service, group and type of waste, classifying it according to the production of
the different services and visualizing graphs to determine the behavior of biocontaminated waste. The analysis was carried out using
the minitab 19 [35].
3. Results
3.1. Generation of solid hospital waste
The nineteen classied services generate 92.77 kg/day
−1
of waste and their generation range from 1.01 kg/day
−1
trauma shock
service to 11.67 kg/day
−1
ICU hospitalization service (Table 2). Biocontaminated waste is at 57.76 kg/day
−1
(62.26 %), these come
from patient care Solid waste contaminated with secretions, excretions and other organic liquids from patient care, including food
waste. Among them, sharps waste reaches up to 7.14 kg/day-1 (7.7 %), including hypodermic needles, pipettes, scalpels, lancets,
Fig. 2. Infraestructura destinada a la disposici´
on nal de residuos hospitalarios (A); Truck for exclusive use in the transport of hospital waste (B).
Table 1
Description of the 19 services evaluated.
Area Service
Hospitalization Medicine
Surgery
Pediatrics
Isolated
Uci
Respiratory ICU
Uviclin
Emergency Trauma shock
Obsrv. Women
Male Observers
Gynecology Hospitalization 1
Hospitalization 2
Hospitalization 3
Topical gynec. Obstetrics
Obs. Ginic.
Accommodation con-jointly
Neonatology
Emergency gynecology
Maternity ward
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
5
Table 2
Description of solid hospital waste from the “Gustavo Lanatta Lujan” - Bagua support hospital.
Area Service Common Biocontami-nates Punzocortan-tes Specials Total
a
N◦BEDS Kg/bed/day m
3
/bed/day
Kg/day m
3
/day Kg/day m
3
/day Kg/day m
3
/day Kg/day m
3
/day Kg/day m
3
/day
Hospitalization Medicine 1.87 0.01373 6.80 0.03489 1.2 0.00849 0.171 0.00159 10.04 0.0587 12 0.8368 0.0049
Surgery 1.32 0.01039 3.60 0.02079 – – 0.32 0.00212 5.24 0.0333 14 0.3743 0.0024
Pediatrics 1.21 0.00978 3.04 0.01654 – – 0.151 0.00106 4.40 0.0274 9 0.4890 0.0030
Isolated 1.35 0.01183 2.60 0.01540 – – 0.097 0.00053 4.05 0.0278 3 1.3490 0.0093
Uci 2.43 0.01259 7.37 0.04088 1.87 0.01292 – – 11.67 0.0664 9 1.2967 0.0074
Respiratory ICU 2.29 0.01388 6.94 0.03921 1.21 0.00831 0.314 0.01168 10.75 0.0731 8 1.3443 0.0091
Uviclin 0.94 0.00751 1.86 0.01289 – – 0.58 0.00372 3.38 0.0241 4 0.8450 0.0060
Emergency Trauma shock 0.68 0.00452 0.126 0.00106 – – 0.206 0.00159 1.01 0.0072 1 1.0120 0.0072
Obsrv. Women 2.22 0.01292 3.86 0.02533 – – – – 6.08 0.0382 10 0.6080 0.0038
Male Observers 1.83 0.01221 2.63 0.01752 – – – – 4.46 0.0297 10 0.4460 0.0030
Gynecology Hospitalization 1 0.59 0.00602 2.18 0.01813 1.46 0.01009 – – 4.23 0.0342 6 0.7050 0.0057
Hospitalization 2 0.57 0.00540 2.48 0.01494 – – – – 3.05 0.0203 8 0.3813 0.0025
Hospitalization 3 0.84 0.00796 1.74 0.01199 – – 0.92 0.00690 3.50 0.0268 8 0.4375 0.0034
Topical gynec. Obstetrics 0.766 0.00705 1.36 0.00895 – – – – 2.13 0.0160 3 0.7087 0.0053
Gynecology Observation Room 0.880 0.00667 1.28 0.00842 – – – – 2.16 0.0151 3 0.7200 0.0050
Accommodation con-jointly 1.410 0.01407 1.84 0.01418 1.4 0.00956 – – 4.65 0.0378 2 2.3250 0.0189
Neonatology 1.21 0.00789 3.01 0.01904 – – 0.58 0.00478 4.80 0.0317 4 1.2000 0.0079
Emergency gynecology 1.42 0.00966 1.94 0.01267 3.36 0.0223 8 0.4200 0.0028
Maternity Ward 0.712 0.00726 3.1 0.02003 – – – – 3.81 0.0273 1 3.8120 0.0273
Total 24.54 0.18133 57.76 0.35284 7.14 0.04937 3.339 0.03397 92.77 0.6175 123 1.0163 0.0050
a
Type of waste by groups disposed in the biosafety cell; “Group A (Biocontaminated), Group A - 5 (Sharps), Group B (Special), Group C (Common)"; -Data not reported.
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
6
broken culture plates, catheters with needles, venoclysis equipment, broken ampoule vials, slides and covers, among other broken
glass or sharps discarded. Common waste is generated in the amount of 24.54 kg/day
−1
(26.45 %), being those wastes that have not
been in contact with patients (generated in ofces, corridors, common areas, cafeterias, auditoriums, etc.). Ofces, corridors, common
areas, cafeterias, auditoriums) and special wastes 3339 kg/day
−1
, these wastes have physical and chemical characteristics of potential
Fig. 3. Behavior of hospital waste; A)Hospitalization medicine; B) Hospitalization surgery; C) Pediatric hospitalization; D) Isolated hospitalization;
E) ICU hospitalitalization; F) Respiratory hospitalization; G)Uviclin; H) Emergency Trauma Schock; I) Emergency Women’s Observation; J)
Emergency Male Observation; K) Gynecology Hospitalization 1; L) Gynecology Hospitalization 2; M) Gynecology Hospitalization 3; N) Topical
Gynecology; O) Gynecology Observation Room; P) Gynecology joint accommodation; Q) Gynecology Neonatology; R) Emergency gynecology; S)
Maternity ward
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
7
danger due to their corrosive, ammable, toxic, explosive, reactive and radioactive nature for the exposed person. A total of 73.56 % of
the waste is disposed of in the biosafety cell and 26.45 % is transported by a compactor vehicle of the Bagua Provincial Municipality.
Fig. 3 shows that there is inadequate segregation of solid hospital waste in the 19 services; it can be seen that the red line for
biocontaminated re-waste is above the black line for communal waste, which shows that the capacity of the containers is inadequate. In
addition, it is evident that in the “ICU respiration” area up to 2.29 kg/day of common waste was generated, with respect to special
waste it reached 0.314 kg/day (Fig. 3F) and in the ICU area the largest amount of sharps waste (1.87 kg/day) was evidenced (3E).
4. Discussion
The study showed that there is limited information on the quantities and characteristics of the various types of waste generated in
Fig. 3. (continued).
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
8
health care centers. In this case, of the nineteen (19) services studied, 92.77 kg/day
−1
were generated; these values are higher than
those found by Ref. [36], who reported 3.23 kg/day-bed; this may be associated with the facilities provided by the establishments;
some services may be very basic and, therefore, the amounts of waste generated are relatively small. The study by Herrera [37] found
that the class of waste with the highest generation corresponds to biocontaminated waste, which reached 391 kg/day, higher values
than in our study. Biocontaminated waste may contain concentrations of microorganisms that are potential public health hazards [38]
and their effects are continually increasing in the environment [39]. In this sense, it is important to characterize the waste for the
implementation of biosafety cells, which allow controlling the contamination of waste generated in health facilities [39]. Given that
every health care facility must implement a solid waste treatment method according to its size, level of complexity, geographic
location, available resources and technical feasibility, it is essential that the facility’s management system be adapted to the needs of
the facility [40].
The generation of hospital waste ranged from 1.01 kg/day
−1
trauma shock service to 11.67 kg/day
−1
ICU hospitalization service.
Other studies determined that ICU generates 7.1 kg/day of solid waste, the differences between the studies may be due to their focus on
single patient diagnosis and variation in medical practice [41]. There are also evi-dences, that delays in transferring patients out of the
ICU, decision making in procedures was among the most common that increases waste and varies depending on the medical staff [42].
Biocontaminated waste 62.26 % of the biocontaminated waste comes from medical waste and biocontaminated waste is the most
common in hospitals, and can represent up to 80 % by weight [43]. These wastes belong to group A and are above the other groups
(Group C–B), followed by group C of common wastes. However, specic studies on hospital waste management are very limited [44].
The common waste generated in the hospital was 24.54 kg/day
−1
, which generally comes from food production, ofce work,
sweeping, maintenance work and even gardening [45]. Therefore, management must be safe and efcient to avoid the proliferation of
diseases [46]. Recently, strategies for the implementation of an effective management of hospital waste towards an environmentally
friendly and sustainable health care environment should be addressed [47].
We found 7.14 kg/day
−1
of sharps waste and 3.339 kg/day
−1
(3.6 %) of special waste, which is generally the product of injections
(needles), lancets, broken glass, sample tubes and can transmit blood-borne pathogens such as HIV [48]. Type III (special) waste would
be infectious materials from anatomic pathology, microbiology, hematology and biochemistry laboratories [49] and should therefore
be managed in a very efcient manner.
And, therefore, must be managed very efciently, from its origin to its nal disposal, in order to avoid occupational hazards in the
establishments [50]. The Ministry of Health (MINSA) is responsible for regulating, supervising and overseeing the management and
management of solid waste from medical establishments, as well as waste generated by health campaigns.
The study showed that only 73.56 % is disposed of in the Bagua biosafety cell and 26.45 % is collected by a Bagua Provincial
Municipality compactor for nal disposal. However, Supreme Decree No. 014 (MINAM, 2017b) establishes that the nal treatment of
hazardous and non-hazardous solid waste depends directly on the central government and should be treated differently from urban
solid waste.
Therefore, it is recommended that future work address management strategies to improve hospital waste management in urban and
rural areas of northern Amazonas, taking into account new and emerging appropriate technologies [51].
Fig. 3. (continued).
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
9
Peru has hospital waste management policies (Health Technical Standard N◦144-MINSA/2018/DIGESA) was approved by Min-
isterial Resolution N◦1295-2018-MINSA, whose objective lies in the safety of employees, patients and visitors to medical facilities,
health care services and public and private research centers, to prevent risks in medical management and environmental management.
The Ministry of Health (MINSA), through the General Directorate of Health and Food Safety (DIGESA), is responsible for regulating,
supervising and overseeing solid waste management in medical establishments and support services nationwide.
Likewise, the competent authority should control the health risks derived from the inadequate management of solid waste from
medical establishments and inadequate medical support services [52]. Proper management of hospital waste has a great contribution
to public health, and it is advisable to raise awareness about proper management. In addition, waste collectors should work with safety
equipment [53].
Future research is expected to address a longer period of evaluation of hospital waste and to assess the level of perception by health
care workers regarding hospital waste management. With the aim of predicting organizational changes [53] and formulating
appropriate policies for public health. It is also important that future work incorporates evaluation criteria for hospital waste to avoid
uncertainty in the identication of contamination [54].
5. Conclusions
Bagua is a resource-constrained province in the Amazon region that is experiencing rapid rural-to-urban migration. This has
contributed to challenges such as the effective management of hospital waste. The study showed that 62.26 % is biocontaminated
waste, so measures must be taken to strategically reduce excessive resource consumption and minimize the impact of health services on
public health. It was also estimated that only 73.56 % is disposed of in the hospital biosafety cell and 26.45 % is treated as common
waste (laundry and food waste). This also requires attention for proper management, as it can cause the transfer of infectious vectors.
The scope of the study can be expanded to include the remaining hospitals within the Amazon Region, as well as those operating in
other cities in Peru (depending on data availability) in order to improve hospital waste management. These actions would improve
public health in the cities.
Data availability
The data used to support the ndings of this study are available from the corresponding author upon request.
Funding
This research has been supported by the Faculty of Engineering and Systems and Electrical Mechanics, Universidad Nacional
Toribio Rodríguez de Mendoza de Amazonas (UNTRM).
CRediT authorship contribution statement
Juan Eduardo Suarez Rivadeneira: Writing – review & editing, Writing – original draft, Project administration, Methodology,
Investigation, Formal analysis, Conceptualization. Eduardo Benjamín Suarez Chavarry: Writing – review & editing, Writing –
original draft, Validation, Supervision, Formal analysis. ´
Italo Maldonado Ramirez: Writing – review & editing, Writing – original
draft, Supervision, Methodology, Investigation, Formal analysis. Wilfredo Ruiz Camacho: Writing – review & editing, Writing –
original draft, Validation, Supervision, Methodology, Formal analysis. Edilbrando Vega Calder´
on: Writing – review & editing,
Writing – original draft, Supervision, Methodology, Investigation, Formal analysis. Roberto P´
erez Astonitas: Writing – review &
editing, Writing – original draft, Supervision, Methodology, Formal analysis. Roberto Carlos Santa Cruz Acosta: Writing – review &
editing, Writing – original draft, Supervision, Methodology, Formal analysis. Morales-Rojas Eli: Writing – review & editing, Writing –
original draft, Validation, Supervision, Methodology, Investigation, Formal analysis, Conceptualization. Heling Kristtel Masgo
Ventura: Writing – review & editing, Writing – original draft, Supervision, Investigation, Formal analysis. Mayra Pamela Musay´
on
Díaz: Writing – review & editing, Writing – original draft, Supervision, Methodology, Formal analysis.
Declaration of competing interest
The authors declare the following nancial interests/personal relationships which may be considered as potential competing in-
terests:Juan Eduardo Suarez Rivadeneira reports article publishing charges was provided by National University Toribio Rodriguez de
Mendoza of Amazonas. Juan Eduardo Suarez Rivadeneira reports a relationship with National University Toribio Rodriguez de
Mendoza of Amazonas that includes: employment. - If there are other authors, they declare that they have no known competing
nancial interests or personal relationships that could have appeared to inuence the work reported in this paper.
References
[1] E. Janik-Karpinska, R. Brancaleoni, M. Niemcewicz, W. Wojtas, M. Foco, M. Podogrocki, M. Bijak, Healthcare waste—a serious problem for global health,
Healthcare (Switzerland) 11 (2023).
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
10
[2] A.A. Hassan, T. Tudor, M. Vaccari, Healthcare waste management: a case study from Sudan, Environments - MDPI 5 (2018) 1–16, https://doi.org/10.3390/
environments5080089.
[3] M. Karamouz, B. Zahraie, R. Kerachian, N. Mahjouri, A. Moridi, Development of a master plan for industrial solid waste management, Int. J. Environ. Sci.
Technol. 3 (2006) 229–242, https://doi.org/10.1007/BF03325930.
[4] C. Cayo-Rojas, G. Brice˜
no-Vergel, N. C´
ordova-Limaylla, J. Huamani-Echaccaya, M. Castro-Mena, P. Lurita-C´
ordova, J. Bermúdez-Mendoza, C. Allen-Revoredo,
J. Torres-V´
asquez, M. Ladera-Casta˜
neda, Impact of a virtual educational intervention on knowledge and awareness of biomedical waste management among
Peruvian dental professionals, Sci. Rep. 13 (2023) 1–11, https://doi.org/10.1038/s41598-023-49878-5.
[5] M.M. Hasan, M.H. Rahman, Assessment of healthcare waste management Paradigms and its Suitable treatment Alternative: a case study, Journal of
Environmental and Public Health 2018 (2018), https://doi.org/10.1155/2018/6879751.
[6] E.M. Veilla, V.M. Samwel, Assessment of sharps waste management practices in a referral hospital, Afr. J. Environ. Sci. Technol. 10 (2016) 86–95, https://doi.
org/10.5897/ajest2015.1939.
[7] A.A. Yusuf, O. Peter, A.S. Hassan, L.A. Tunji, I.A. Oyagbola, M.M. Mustafa, D.A. Yusuf, Municipality solid waste management system for Mukono District,
Uganda, Procedia Manuf. 35 (2019) 613–622, https://doi.org/10.1016/j.promfg.2019.06.003.
[8] R.G. Mihaileanu, I.A. Neamtiu, M. Fleming, C. Pop, M.S. Bloom, C. Roba, M. Surcel, F. Stamatian, Gurzau, EugenAssessment of heavy metals (total chromium,
lead, and manganese) contamination of residential soil and homegrown vegetables near a former chemical manufacturing facility in Tarnaveni, R. Assessment of
heavy metals (total chromium, lead, and manganese) contamination of residential soil and homegrown vegetables near a former chemical manufacturing facility
in Tarnaveni, Romania, Environ. Monit. Assess. 191 (2019), https://doi.org/10.1007/s10661-018-7142-0.
[9] J.A. Snowdon, D.O. Cliver, J.C. Converse, Land disposal of mixed human and animal wastes: a review, Waste Manag. Res. 7 (1989) 121–134, https://doi.org/
10.1177/0734242X8900700117.
[10] E. Sozzi, K. Fabre, J.F. Fesselet, J.E. Ebdon, H. Taylor, Minimizing the risk of disease transmission in emergency settings: Novel in situ physico-chemical
disinfection of pathogen-laden hospital Wastewaters, PLoS Neglected Trop. Dis. 9 (2015), https://doi.org/10.1371/journal.pntd.0003776.
[11] L. Ismark, A. Gonz´
alez Díaz, Manejo de los Desechos Peligrosos Hospitalarios, vol. 36, 2005.
[12] R. Bakiu, S. Durmisahaj, SF journal of environmental and Earth Science medical waste effects and management : Overview and future directions, Science
Forecast Journal of Environmental and Earth Science 1 (2018) 1–13.
[13] H. Ghali, A. Ben Cheikh, S. Bhiri, L. Bouzgarrou, M. Ben Rejeb, I. Gargouri, H.S. Latiri, Health and environmental impact of hospital wastes: systematic review,
Dubai Med. J. 6 (2023) 67–80, https://doi.org/10.1159/000529432.
[14] B.A. Khan, L. Cheng, A.A. Khan, H. Ahmed, Healthcare waste management in Asian developing countries: a mini review, Waste Manag. Res. 37 (2019) 863–875,
https://doi.org/10.1177/0734242X19857470.
[15] OMS Residuos s´
olidos Available at: https://www.paho.org/es/temas/residuos-solidos.
[16] A.M. Osman, Z. Ukundimana, F.B. Wamyil, A.A. Yusuf, K. Telesphore, Quantication and characterization of solid waste generated within Mulago national
referral hospital, Uganda, East Africa, Case Studies in Chemical and Environmental Engineering 7 (2023) 100334, https://doi.org/10.1016/j.
cscee.2023.100334.
[17] M.H. Mushtaq, F. Noor, M.A. Mujtaba, S. Asghar, A.A. Yusuf, M.E.M. Soudagar, A. Hussain, M.F. Badran, K. Shahapurkar, Environmental performance of
alternative hospital waste management strategies using life cycle assessment (LCA) approach, Sustainability 14 (2022), https://doi.org/10.3390/su142214942.
[18] D. Abarca, F. Escobar, Health waste management: an educational program from knowledge to practice, Journal of High Andean Research 20 (2018) 315–324.
[19] A. Nkonge Njagi, A. Mayabi Oloo, J. Kithinji, Magambo Kithinji, J. Knowledge, Attitude and practice of health-care waste management and associated health
risks in the two teaching and referral hospitals in Kenya, J. Community Health 37 (2012) 1172–1177, https://doi.org/10.1007/s10900-012-9580-x.
[20] A. Diaz-Soriano, Knowledge and awareness of effective recycling of dental materials and waste management among Peruvian undergraduate students of
dentistry: a logistic regression analysis, J. Int. Soc. Prev. Community Dent. 8 (2005) 34–37, https://doi.org/10.4103/jispcd.JISPCD.
[21] J.L.R. Esteban Jim´
enez, J.C. Mayorga Rojas, J.M. Calder´
on de Alvarado, Gesti´
on de residuos biocontaminados en establecimientos de salud administrados por
los gobiernos regionales del Perú, Revista del Instituto de investigaci´
on de la Facultad de minas, metalurgia y ciencias geogr´
acas 25 (2022) 93–101, https://
doi.org/10.15381/iigeo.v25i49.23016.
[22] MINSA Norma T´
ecnica de Salud N◦144-MINSA, Gesti´
on Integral y Manejo de Residuos S´
olidos en Establecimientos de Salud, Servicios M´
edicos de Apoyo y
Centros de Investigaci´
on, Ministerio de Salud, 2018, pp. 1–88.
[23] GESTI´
ON Residuos hospitalarios: ¿El Perú cuenta con un sistema adecuado para su gesti ´
on y eliminaci´
on? Available at: https://gestion.pe/tendencias/estilos/
residuos-hospitalarios-el-peru-cuenta-con-un-sistema-adecuado-para-su-gestion-y-eliminacion-noticia/.
[24] Kaza, S.; Yao, L.C.; Bhada-Tata, P.; Van Woerden, F. What a waste 2.0: a global snapshot of solid waste management to 2050. What a Waste 2.0: A Global
Snapshot of Solid Waste Management to 2050 2018, 3–4, doi:10.1596/978-1-4648-1329-0.
[25] N. Requena-Sanchez, D. Carbonel-Ramos, S. Moonsammy, R. Klaus, L.S. Punil, K.T.W. Ng, Virtual methodology for household waste characterization during the
pandemic in an urban district of Peru: citizen science for waste management, Environ. Manag. 69 (2022) 1078–1090, https://doi.org/10.1007/s00267-022-
01610-1.
[26] M. Karamouz, B. Zahraie, R. Kerachian, N. Jaafarzadeh, N. Mahjouri, Developing a master plan for hospital solid waste management: a case study, Waste
Management 27 (2007) 626–638, https://doi.org/10.1016/j.wasman.2006.03.018.
[27] R.M. Minsa, N◦217 - 2004, 2004. ISBN 9972851141.
[28] M.E.S. Dds, Dental Clinics of North America Hazardous Waste Management, vol. 35, 1991, pp. 1990–1991.
[29] Z. Chu, Q. Li, A. Zhou, W. Zhang, W. chiao Huang, J. Wang, Strategy formulation path towards zero-waste of municipal solid waste: a case study from Shanghai,
J. Clean. Prod. 418 (2023) 138091, https://doi.org/10.1016/j.jclepro.2023.138091.
[30] S.Y. Mateo, J.C. Guzm´
an-Cuzcano, E.R. Pe˜
na-S´
anchez, C. Yon, B. Valderrama, J. Carrasco, L. La Torre, F. Chapilliquen, M. Aguilar, E. Quezada, et al.,
Knowledge, attitudes, practices and perceptions about zika in women of childbearing age in Amazonas, Peru, Rev. Peru. Med. Exp. Salud Pública 38 (2021)
551–561, https://doi.org/10.17843/rpmesp.2021.384.8558.
[31] INEI Censos Nacionales 2017, XII de Poblaci´
on, VII de Vivienda y III de Comunidades Indígenas 506 (2018) 2–5.
[32] SENAMHI Climas del Perú - Mapa de Clasicaci´
on Clim´
atica Nacional, 2021. ISBN 9788578110796.
[33] MINSA NORMA T´
ECNICA DE SALUD: “GESTI´
ON INTEGRAL Y MANEJO DE RESIDUOS S ´
OLIDOS EN ESTABLECIMIENTOS DE SALUD, SERVICIOS M´
EDICOS DE
APOYO y CENTROS DE INVESTIGACI´
ON”.
[34] A. Cantahede, L. Sandoval, G. Monge, C. Caycho, Procedimientos estadísticos para los estudios de caracterizaci´
on de residuos s´
olidos, Hoja de divulgacion
tecnica - OPS/CEPIS (2005) 1–8.
[35] Minitab Introducci´
on a Minitab 19 para Windows, Minitab 19 (2020) 65.
[36] L.F. Diaz, L.L. Eggerth, S. Enkhtsetseg, G.M. Savage, Characteristics of healthcare wastes, Waste Management 28 (2008) 1219–1226, https://doi.org/10.1016/j.
wasman.2007.04.010.
[37] M. Herrera Rojas, R.S. Lazo Ramos, Sistema de gesti´
on de residuos s´
olidos hospitalarios para reducir el impacto ambiental en un hospital de seguridad social de
Tacna – 2018, Revista Veritas Et Scientia - Upt 8 (2020) 1192–1201, https://doi.org/10.47796/ves.v8i2.136.
[38] B.T. Odumosu, Biomedical waste: its effects and safe disposal, Environ. Waste Manag. (2016) 81–93, https://doi.org/10.1201/b19243-8.
[39] M. Samant, S.C. Pandey, A. Pandey, Impact of hazardous waste material on environment and their management strategies, Microbial Biotechnology in
Environmental Monitoring and Cleanup (2018) 175–192, https://doi.org/10.4018/978-1-5225-3126-5.ch011.
[40] MINSA NORMA T´
ECNICA, PROCEDIMIENTOS PARA EL MANEJO DE RESIDUOS S ´
OLIDOS HOSPITALARIOS (R.M. N◦217 - 2004/MINSA), 2004. ISBN
9972851141.
[41] P.A. Prasad, D. Joshi, J. Lighter, J. Agins, R. Allen, M. Collins, F. Pena, J. Velletri, C. Thiel, Environmental footprint of regular and intensive inpatient care in a
large US hospital, Int. J. Life Cycle Assess. 27 (2022) 38–49, https://doi.org/10.1007/s11367-021-01998-8.
J.E. Suarez Rivadeneira et al.
Heliyon 10 (2024) e31814
11
[42] K.F. Almoosa, K. Luther, R. Resar, B. Patel, Applying the new institute for healthcare improvement inpatient waste tool to identify “waste” in the intensive care
unit, J. Healthc. Qual. 38 (2016) e29–e38, https://doi.org/10.1097/JHQ.0000000000000040.
[43] M. Singh, N. Karimi, K.T.W. Ng, D. Mensah, D. Stilling, K. Adusei, Hospital waste generation during the rst wave of COVID-19 pandemic: a case study in Delhi,
Environ. Sci. Pollut. Control Ser. 29 (2022) 50780–50789, https://doi.org/10.1007/s11356-022-19487-2.
[44] C. Dias-Ferreira, T. Santos, V. Oliveira, Hospital food waste and environmental and economic indicators - a Portuguese case study, Waste Management 46 (2015)
146–154, https://doi.org/10.1016/j.wasman.2015.09.025.
[45] I.A. Nwosu, J.O. Ekpechu, V.C. Njemanze, B. Semidara, E.C. Eyisi, B. Ohuruogu, P.E. Nwazonobi, U.N. Umanah, W.C. Clement, C.O. Aleke, et al., Assessment of
awareness, attitude, and consequences of healthcare waste among health workers at health facilities in southeast Nigeria, Sage Open 14 (2024) 1–14, https://
doi.org/10.1177/21582440241229598.
[46] K.K. Padmanabhan, D. Barik, Health Hazards of Medical Waste and its Disposal, Elsevier Ltd., 2018. ISBN 9780081025284.
[47] S.M. Lee, D.H. Lee, Effective medical waste management for sustainable green healthcare, Int. J. Environ. Res. Publ. Health 19 (2022), https://doi.org/10.3390/
ijerph192214820.
[48] P.L. Moro, A. Moore, P. Balcacer, A. Montero, D. Diaz, V. G´
omez, Z. Garib, B.G. Weniger, Epidemiology of needlesticks and other sharps injuries and injection
safety practices in the Dominican Republic, Am. J. Infect. Control 35 (2007) 552–559, https://doi.org/10.1016/j.ajic.2007.06.001.
[49] S. Llorente ´
Alvarez, P. Arcos Gonz´
alez, R. Gonz´
alez Estrada, Evaluaci´
on de la gesti´
on hospitalaria de residuos sanitarios en el Principado de Asturias, Rev. Esp.
Salud Publica 71 (1997) 189–199, https://doi.org/10.1590/s1135-57271997000200010.
[50] L. Lafuente, L. Chacon, M. Machado, G. Marcus, L. Rojas, Manejo de residuos s´
olidos hospitalarios y riesgo laboral del enfermero, Revista Cientica de Salud
UNITEPC 6 (2018) 2–5.
[51] K. Zimmermann, Microwave technologies: an emerging tool for inactivation of biohazardous material in developing countries, Recycling 3 (2018), https://doi.
org/10.3390/recycling3030034.
[52] R. Díaz, A.J.D.S.R.S. de los, Desechos hospitalarios: aspectos educativos en la implementaci´
on de su manejo, Rev. Cubana Hig. Epidemiol. 38 (2000) 195–200.
[53] D.C. Wilson, C. Velis, C.R. Cheeseman, I. Nollet, Waste management and research: the journal for a sustainable circular economy, Waste Manag. Res. 5 (2019)
3–4.
[54] A. Abed-Elmdoust, R. Kerachian, Regional hospital solid waste assessment using the evidential reasoning approach, Sci. Total Environ. 441 (2012) 67–76,
https://doi.org/10.1016/j.scitotenv.2012.09.050.
J.E. Suarez Rivadeneira et al.