Application of the DPSEEA Model to Healthcare Waste Management

Stedile, Nilva Lúcia Rech; Schneider, Vania Elisabete; Nunes, Monique Walltrick; Kappes, Adriane Carine

doi:10.1590/1413-812320182311.19352016

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FREE THEMES • Ciênc. saúde colet. 23 (11) • Nov 2018 • https://doi.org/10.1590/1413-812320182311.19352016 copy

Application of the DPSEEA Model to Healthcare Waste Management

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

The use of health indicators is indispensable for understanding the complex relationship between the environmental and health fields. For the proposition of environmental health indicators, the Brazilian Ministry of Health (MH) recommends using a model proposed by the World Health Organization. This model is composed of the following elements: Driving Force, Pressure, State, Exposure, Effect, and Action; it is called the DPSEEA model. The objective of this study is to propose the application of this model in healthcare waste (HCW) management. This study was performed by documentary research using two data sources: a) technical reports on research on HCW from the last 15 years (outpatient, dental, hospital, veterinary, university, and primary care unit) at the University of Caxias do Sul, Brazil; and b) the MH manual entitled “Environmental Health: Basic Guide for the Construction of Indicators”. The results show that the model is relevant because it makes it possible to analyse a particular context, proposing indicators and defining specific actions for the case of this study, to monitor and improve methods of managing HCW. The results also show that the proposed model is an important analytical tool for both medical waste management and planning actions that will minimize risks, particularly chemical and biological, resulting in environmental health and protection.

Environmental health; Health indicators; Healthcare waste

Title	Year	Place of origin	Selection Criteria
Environmental Health Manual: Basic Guide for the Construction of Indicators	2011	Brazilian Ministry of Health	This text is the basic guide for the formulation of environmental health indicators in Brazil.

Technical reports of the following studies:		ISAM/UCS (Environmental Sanitation Institute of the University of Caxias do Sul)	The technical reports contain reliable data on HCW management at different generating sources, including management indicators of interest for this study.
Systematization of solid waste sources from healthcare services	2000
Study of solid dental waste generation (SDWG) in the city of Caxias do Sul as support for the formulation of management policies	2001
Solid waste management in basic health units in the city of Caxias do Sul – Information for model development	2005
Systematization of HCW in universities	2008
Management of HCW in teaching hospitals and outpatient clinics	2009
Waste management in healthcare and research units at the University of Caxias do Sul: Assessment of scenarios and perspectives	2010/ 2011
Healthcare waste: The impact of a permanent education programme on the segregation and minimization of generation	2013
Systematization of veterinary waste generating sources: Mapping for the development of management models	2015
Health permanent education and information as strategies for strengthening primary care	2015

Model Level	Determinants	Indicators	Actions
Driving Force	Current economic model.	GDP per capita. Sustainable development indicators. Urbanization and population growth rates. Vehicle fleet index. Air and water quality rates. Employment and income rates. Increase in disposable use index.	Establish and implement public policies for sustainable development. Implement environmental education for communities in formal education situations. Reduce the emission of pollutants in air, soil, and water. Modify the healthcare services logic, emphasizing prevention. Promote quality of life, access to education, health, work, and safety. Promote actions for health education and the prevention of diseases and injuries.
Driving Force	Organizational logic of healthcare.	Hospitalization rate in healthcare services. Chronic disease rate. Mortality rate. Morbidity rate.
Pressure	Increase in services at healthcare facilities (primary health units, clinics, outpatient clinics)	Hospital occupancy rate. Healthcare service rate. Rate of procedures performed.	Promote a healthy lifestyle that does not cause the population to become sick. Reduce hospitalizations and the need for healthcare service procedures through promotional and preventive action. Educate healthcare professionals in sustainable materials use. Appropriately store, treat, and dispose of each type of HCW according to its classification and handling. Minimize HCW generation and encourage reuse and recycling.
	Increase in HCW generation.	Index of HCW generated by establishment type. Existence of an HCW management plan. HCW management costs. HCW generation rate per bed. HCW generation rate per procedure.
	Increase in the demand for the appropriate treatment and final disposal of HCW	Volume of waste generated and segregated. Amount of packaging containers. Existence of a permanent education training programme that includes the topic of waste. Final disposal costs.
Situation	Environmental contamination, mainly by infectious and chemical waste, changing water, soil, and air quality.	Water and soil quality indicators. Air quality indicators. Environmental pollution rate. Rate of emission of gases in the atmosphere.	Protect groundwater and water sources. Reduce drinking water contamination. Decrease the use of drinking water for waste treatment. Reuse water. Reduce the emission of polluting gases to promote air quality. Treat all chemical waste before disposal. Treat all infectious waste before discarding and/or final disposal. Develop and implement an HCW management plan. Supervise facilities responsible for HCW treatment. Supervise regular landfills and hazardous industrial waste landfills.
	Risk of increased number of occupational accidents.	Rate of occupational accidents. Work leave days Occupational accident treatment costs. Index of contamination due to work accident.	Segregate waste appropriately. Promote permanent education actions to prevent and monitor the causes of accidents. Correct use of personal protective equipment (PPE).
	Increased risk of infections.	Hospital infection rate. Cross infection rate. Rate of rehospitalization due to infection.	Discourage inappropriate forms of management. Proper segregation, disposal, packaging, collection, and transportation of waste.
Exposure	Population exposed to a higher number of determinant factors of health impairment.	Hospital occupancy rate. Incidence of respiratory diseases in children and the elderly. Hospitalization rate due to respiratory problems. Hospitalization rate due to chronic diseases. Readmission rates.	Promote public policy related to water, soil, and air quality. Integrate institutional actions with epidemiological and environmental surveillance actions.
	Water and soil potentially contaminated by medications and other chemicals.	Water quality. Rate of contaminants present in water. Rate of households with potable water. Rate of coverage of selective collection.	Promote public policy for water protection and correct use for activities. Train health institutions (professionals and users) in correct HCW segregation. Reduce the contamination of water sources and groundwater via correct handling and treatment of waste. Reduce water waste.
	High air pollution rates and polluting gases.	Air quality. Rate of emission of polluting gases. Rate of polluting gases present in ambient air.	Establish an environmental protection policy to promote air quality for the population and the environment. Reduce pollutant emission into the atmosphere. Decrease vehicle fleet. Decrease release of untreated gases. Monitor incinerator efficiency.
	Exposure to pathogens or hazardous waste (chemicals) due to inappropriate management.	Occupational disease rate. Index of occupational accidents for health professionals. Rate of work leave due to occupational injuries or illnesses. Rate of hospital occupancy due to respiratory disease.	Educate professionals to handle waste properly. Encourage the use of PPE and Collective Protective Equipment (CPE). Provide PPE according to the risk level. Promote surveillance and healthcare measures. Establish a flow for notification of diseases and injuries. Establish measures for disease prevention. Prepare and implement an HCW management plan. Comply with all existing legal provisions.
Effect	Infectious diseases transmitted by sharps.	Rate of sharps injuries. Rate of retrovirals use by injured health professionals. Hospital occupancy rate due to infectious diseases. Rate of outbreaks due to diarrhoeal diseases. Rate of diseases transmitted by potentially contaminated and altered natural elements.	Promote in institutions permanent education on biosafety and HCW. Promote appropriate treatment of injured professionals. Promote appropriate forms and processes for the storage, treatment, and disposal of waste.
	Increased infection rate.
	Increase in diseases and health problems caused by water, soil, and air components.

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[1] Collaborations

NLR Stedile worked on the design, data delineation and analysis, critical review and approval of the version to be published. VE Schneider worked on the critical review and approval of the final version. MW Nunes worked on article writing, research, methodology, data analysis. AC Kappes worked on data analysis and critical review.