Medical waste from hospitals and other healthcare institutions has become an imperative environmental and public safety problem. Medical waste in Greece has become one of the most urgent environmental problems, because there are 14 000 tons produced annually, of which only a small proportion is incinerated. In the prefecture of Attica there is only one modern municipal medical waste incinerator (started 2004) burning selected infectious hospital waste (5—6 tons day^{— 1}). Fly and bottom residues (ashes) are collected and stored temporarily in barrels. High values of metal leachability prohibit the landfilling of these ashes, as imposed by EU directives. In the present study we determined quantitatively the heavy metals and other elements in the fly and bottom ashes of the medical waste incinerator, by inductively coupled plasma emission spectrometry (ICP) and by energy dispersive X-ray analysis (EDAX). Heavy metals, which are very toxic, such as Pb, Cd, Ni, Cr, Cu and Zn were found in high concentrations in both fly and bottom ashes. Metal leachability of fly and bottom ashes by water and kerosene was measured by ICP and the results showed that toxic metals in both ashes, such as Pb, Cr, Cd, Cu and Zn, have high leaching values. These values indicate that metals can become soluble and mobile if ash is deposited in landfills, thus restricting their burial according to EU regulations. Analysis of polychlorinated biphenyls and polycyclic aromatic hydrocarbons in fly and bottom ashes showed that their concentrations were very low. This is the first known study in Greece and the results showed that incineration of medical waste can be very effective in minimizing the most hazardous and infectious health-care waste. The presence of toxic metals with high leachability values remains an important draw back of incineration of medical waste and various methods of treating these residues to diminish leaching are been considered at present to overcome this serious technical problem.

The wide variety of activities at healthcare facilities generates different types of waste. There is always a danger of spreading infection due to mishandling of infectious waste or sharps. Hence, a variety of policies and actions have been taken to improve healthcare waste management systems. A large body of literature is available which suggests methods for tackling different problematic situations but management is confronted with a variety of complex problems, such as the choice of technological options to control infection, legal and budget restrictions and the timely removal of waste, which can, at times, conflict with each other. Hence, a planning model is presented that is based on a trans-shipment goal programming approach wherein the waste flow is optimized for multiple objectives under different priority structures or with different relative importance (weights). The use of the model is demonstrated as a decision-making tool that would help the management to understand the effects of their policies on the system performance. The model is validated for a case application representing a real-life situation. It can be easily seen that, in the case in which the management is biased toward a higher level of safety protection towards infection control, they have to compromise on cost control and to some extent on environmental pollution control.

The cornerstone for an effective biomedical waste (BMW) management is appropriate waste segregation. Improper waste segregation practices can have an adverse impact on public health and increase the cost of treatment. Deficiencies in waste segregation practices can be corrected by continuous monitoring and education. Manpower for monitoring waste segregation in a large teaching hospital is scanty. We utilized the undergraduate medical students as monitors and studied the impact on waste segregation practices. A prospective observational study was carried out from August 2004 to January 2005. For monitoring waste segregation, the different areas of the hospital were divided amongst the II M.B.B.S students. They were provided with an observation sheet wherein the status of waste segregation and overall hygiene was recorded on a scale of 1—5. The impact of this programme was then analysed over the study period. The results indicated that a statistically significant improvement in waste segregation practices occurred in all areas. Thus, a large hospital with a medical college can identify students or a similar group for monitoring waste segregation or other aspects of biomedical waste management. This will improve their understanding of good practice in BMW management in future.