Article Preview
TopIntroduction
Among the environmental topics discussed, the public control of urban and medical waste has gained notoriety, making it necessary to understand the role of Reverse Logistics (RL). As an example, in order to control the spread of an epidemic, the effective management of rapidly increased medical waste through establishing a temporary RL system is of vital importance, mainly in this COVID – 19 pandemic period (Yu, Sun, Solvang, & Zhao, 2020).
In both public and private health management, the waste generated by health service establishments deserves special attention in terms of their control and final disposal. However, disposal of medical waste from home, and for that matter, solid waste, varies tremendously around the world (Krisiunas, 2011).
Medical Waste Management (MWM) has become a critical issue as it poses potential public health risks due to its potential environmental pollution/hazards, and one of the challenges associated with MWM is the lack of policies and regulations (Awodele, Adewoye, & Oparah, 2016). According to the United States Environmental Protection Agency - EPA (2017) sharps disposal by self-injectors is not typically regulated, and self-injectors do not always know the safest disposal methods.
In Brazil, the legal guidelines about health waste disposal do not include management of the disposal of household produced (EcoDebate, 2011). The Resolution n. 222 of National Agency of Health Surveillance (Anvisa in portuguese) states that the Management of Residues of Health Services (RHS) is a set of management procedures. It seeks to minimize the production of health waste and disposal of any waste generated in a manner that is safe and efficient, aiming at the protection of workers, the preservation of public health, natural resources and the environment (Anvisa, 2018). The RHS are classified in groups, according to their nature and risks, in agreement with the Resolution n. 222 (Anvisa, 2018): group A (infectious waste); group B (chemical waste); group C (radioactive waste); group D (universal or common waste) and group E (sharps waste).
Diabetes Mellitus (DM) is a high-level, global-level chronic disease, and the number of people with diabetes has more than doubled over the past three decades. The use of hypoglycemic agents and a daily insulin injection are necessary because insulin is a hormone that regulates sugar in the blood that (when not controlled) severely damages several organs and systems (Telo, Cureau, Souza, et al., 2016).
The generation of E-residues is directly related to insulin-dependent diabetics. After the self-monitoring of blood, insulin-dependent diabetics also generate in their homes the residues of sharp wastes, which result from glycemic monitoring with lancets and insulin injections (Brazilian Society of Diabetes, 2009).
The International Diabetes Federation (IDF) reported that Brazil had about 14.2 million people with diabetes in 2015, but estimates show that 24.8 million people have glucose intolerance and generate sharp wastes. It is expected that by the year 2040 this will increase by 60%, rising to 48.8 million people with diabetes (IDF, 2015). In Brazil, it was responsible for 5.3% of deaths in 2011, with a mortality rate of 33.7 deaths per 100 thousand inhabitants (Iser, Stopa, Chueiri, et al., 2015).
A study carried out with Brazilian diabetics pointed out that the application of insulin at home was practiced by 88.5% of diabetics interviewed. Regarding blood glucose monitoring at home, about 80% of patients stated that they performed the test with a needle (lancet) for the collection of blood to be deposited on a reagent strip, which measures and reads on digital equipment the blood glucose level. After use, the lancet is also classified as a sharps waste (André, 2012). Ishtiaq, Qadri, Mehar, et al. (2012) reported that of 375 patients that used insulin in Pakistan, the majority of the patients discarded such used devices (syringes, 92%; pens, 75%; and lancets, 91%) in the household garbage collection bin.