Introduction

Medical and veterinary waste manage- ment is one of the many complex and de- manding challenges facing humanity as the global population swells and the demand for medical services increase. Medical waste is classified by the World Health Organization (WHO) as: “waste that is generated in the di- agnosis, treatment or immunization of human beings or animals.” Medical waste that is not properly handled and disposed of represents a high risk of infection or injury to healthcare personnel, as well as a lesser risk to the gen- eral public through the spread of micro-or- ganisms from healthcare facilities into the environment.As a result, the environmental pollution problems caused by waste produc- tion have attracted the attention of research- ers (Oweis, Al-Widyan, & Al-Limoon, 2005; Sharma & Gupta, 2017; Windfeld & Brooks, 2015). To ensure the health of humans and animals, in addition to environmental protec- tion, proper management  of waste  disposal is very important. Hospital and infectious wastes are one of the most dangerous envi- ronmental pollutants. According to the re- port of World Health Organization (WHO), hospital waste is produced during diagnos- tic, therapeutic, medical, veterinary and bio- logical activities (Moreira & Günther, 2013; Oweis et al., 2005). Particularly, part of the waste produced in the process of providing health services to hospitals, clinics, medical and veterinary laboratories hazardous wastes is infectious (Komilis, Makroleivaditis, & Nikolakopoulou, 2017). Veterinary waste is an important part of the infectious waste con- taining dangerous and pathogenic agents. On the other hand, the issue of the management of veterinary and medical wastes is a chal- lenge with lack of awareness, general  educa-

tion and absence of adequate funding for the proper implementation. The collection and disposal of these types of waste are import- ant because it directly contributes to creating a variety of risks for public and environmen- tal health (Abdulla, Qdais, & Rabi, 2008). Therefore, as in the case of hazardous medi- cal waste, it is also necessary to decide on the nature and methods of disposal of veterinary waste as a serious threat to human health and the environment(Chen, Liu, Feng, & Chen, 2012; Uysal & Tinmaz, 2004, Coad, 1992; Lee, Ellenbecker, & Moure-Eraso, 2004). This study was conducted  for the first  time to survey the current status of the hazardous and infectious waste management of veter- inary service centers (public and private) in Kermanshah, Western Iran.

Material & Methods

Medical & veterinary waste control reg- ulation of Iran

According to the guidelines, the   National

Environmental Law and the Iranian Ministry of Health have special provisions to control the management of the medical and veteri- nary infectious waste. On that basis, the col- lection, temporary storage,  transportation  and disposal of the waste produced in health centers are divided into six main groups (IN- REH, CWMIM&V, 2005). According to the regulations, solid waste should  be  collect- ed in black plastic bags and recyclable ma- terials in blue bags.  In addition,  according  to clause 11 and 2 of the Hazardous Waste Management legislation of the High Coun- cil of the Environment and the Ministry of Health (Iran’s Medical Waste Control Regu- lation, IMWCR 2008, Iran’s Ministry of En- vironment  and Health,  2008),  sharp objects

should be put in yellow plastic  containers and infectious waste, hazardous chemicals and pharmaceutical waste in red bags with a minimum capacity of 10 kilograms.

Study tool

In this descriptive-analytical project based on the guidelines of the Environmental Pro- tection Agency, Iran's Ministry of Health and the World Health Organization, a question- naire including seven questions about how to manage the waste of veterinary centers was designed (guideline* and questionnaires**). Then  with  direct  referral  and  responding  to the researcher's questions by experts in each department in three public veterinary centers(I) and three private clinics(II) (Clin- ics and laboratories), the questionnaire was completed. In order for more accurate eval- uation, qualitative data (yes or no answers in the items) was turned into quantitative val- ues. Based on this subject, the state of 1. Sep- aration 2. Collection  3. Primary autoclave and non-bacterial culture medium 4. Keeping Temporarily  5. Evanescence at the site  (fur-

Figure 1. The general state of waste management in stud- ied centers

*SC: Standard Center, Public sector (A), (B), (C), Private sector (D), (E), (F)

** S: Separation, CO: Collecting, P: Primary autoclave and non-bacterial culture medium, K: Keeping temporary, SH: Shipment, ES: evanescence at the site (furnace or lime-well), EO: Evacuated outside the place with a special device hazardous waste

nace or lime well (6. Transportation 7. Evac- uated outside the place with a special hazard- ous waste device and disposal of hazardous and infectious wastes, the coefficient 14.285 was considered (in total 100%). General state of waste management for type of study cen- ters was arranged. Favorable (score 1), Av- erage (0.75), Unfavorable (0.5) and   Critical

(0.25). Finally, 14.285 coefficient was used for calculating the above scores. The total score for each question was calculated. The final score of the waste management was re- corded. Data analysis, comparison and rank of public and private centers were performed using SPSS version 22 software with a sig- nificance level (P ≤ 0.05).

1. Three public veterinary centers of Ker- manshah, including veterinary centers of the city NO:1 (A), provincial NO:2 (B) and aca- demic NO:3 (C).
2. Three private veterinary centers of Ker- manshah, including NO:1(D), NO:2(E) and NO:3(F).

Figure 2. The percentage of separation in waste manage- ment in studied centers.

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Figure 3. The percentage of collecting in waste manage- ment in studied centers

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Figure 4. The percentage of primary autoclave and non-bacterial culture medium

in waste management in studied centers

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Table 1:General state of waste management for type of study centers

Veterinary Centers Invested: Standard Condition. (SC). Public sector (A), (B), (C), Private sector (D), (E), (F) Condition: Favorable (1). Average (0.75). Unfavorable (0.5). Critical (0.25) Standard Condition. (SC)

Coefficient Ultimate =14.285

Results

The waste management status of the veter- inary centers was completed on the basis of the checklist. The results showed that the state veterinary sectors (provincial, city adminis- tration and veterinary medical-educational center) with 67.852%, 60.708%, 60.708%, re- spectively, compared with private veterinary clinics (NO:1 clinic, NO:2 clinic and NO:3 clinic) had a better status of 50.394%  (Table 1). The situation of waste separation and col- lection in all public and private centers was medium and average (10.713%). The primary

safe disposal of infectious waste of the mi- crobiological laboratory was carried  out only in public centers with an average condition (14.285%). This process was not carried out  at any of the private centers (0%). The evacu- ation proceeding hazardous infectious wastes in and outside place and shipment of this  waste with special disposal devices in public and private centers with 3.571% & 7.142% respectively, were critical. Also, the unfavor- able grade of all centers was 21.426%. (Table 2). The status of waste management of public and private veterinary centers is shown sepa- rately (Fig.  1 - 8).

Figure 5. The percentage of keeping temporary in waste management in studied centers.

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Figure 6. The percentage of shipment in waste manage- ment in studied centers.

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Figure 7. The percentage of evanescence at the site (fur- nace or lime well)

in waste management in studied centers.

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Figure 8. The percentage of evacuated outside the place with a special device

hazardous waste in waste management in studied centers.

*SC: Standard Condition, Public sector (A), (B), (C), Pri- vate sector (D), (E), (F)

Table 2:General status of the waste management according to the type of medical institution stud- ied Based on the degree of quality (P ≤ 0.05). *Numbers are expressed in percentage terms.

Veterinary Centers Invested: Standard Condition. (SC). Public sector (A),(B), (C), Private sector (D), (E), (F) Condition: Favorable (1). Average (0.75). Unfavorable (0.5). Critical (0.25) Standard Condition. (SC)

Coefficient Ultimate =14.285

Discussion

Focusing on human, animal and environ- mental health with proper waste manage- ment is very important. Infectious waste destroys the environment by contaminating soil and water (directly) and air (indirect- ly).The dangerous nature of the veterinary waste ignorance and the consequences of improper management of this type of waste (such as problems caused by lack of man- agement of chemical uses, pharmaceutical, separation, primary processing, collection, storage, transportation and disposal) cause widespread environmental and health-re- lated problems (Mahasa & Ruhiiga, 2014; Omar, Nazli, Subramaniam, & Karuppan- nan, 2012). Despite special management requirements for medical and hospital infec- tious waste, according to clause 2 of Note 1 of the Iranian Environmental Organization's Waste Management Code, the waste from veterinary clinics is given less attention de- spite the presence of a variety of pathogenic microorganisms dangerous to humans, live- stock and the environment. The increase in the percentage of hazardous waste may be due to the type of hospital waste manage- ment, in particular the separation of hazard- ous waste from usual waste. On the other hand, the lack of training and disregard for the separation and collection of non-infec- tious waste in bags specialized for infectious waste can also be another reason for the in- creased percentage of infectious  waste  that is now more in number than the total waste produced (Bazrafshan & Kord Mostafapoor, 2011). According to the WHO report, about 85% of hospital wastes are safe, 10% in- fectious and about 5% are  non-infectious  but dangerous. However, in some cases, the amount of the latter type of waste has risen as a result of inappropriate management  and

the comixture of general wastes with infec- tious waste (Birchard, 2002; Chartier, 2014; Lee et al., 2004; Mohee, 2005). According  on the results of the present study the low- est produced waste was the chemical waste. In the examined centers, due to not using radio-medication and related compounds in veterinary services, no radioactive waste was observed. It was also found, in some cases, that separation of the waste from the source was not performed correctly, it was possible that some types of waste (drugs, blades, win- ners, etc.) could be replaced in infected bags. In the centers studied, complete separation was not thought to have been fully per- formed between the veterinary waste and the sub-homemade waste (safe). In all centers, the bags were shipped to the temporary stor- age location, without the specified label ex- plaining the contents of the bags. There was no burial place and no carcass burning oven in any of the centers and therefore the critical conditions for the elimination of veterinary waste were 100% neglected. Also, the waste of the studied centers was not kept away from the effects of climate factors. In all cen- ters of temporary storage tanks,  they  were not sterilized and penetrated for moisture. Accession to veterinary waste from the place of production to the temporary storage facil- ity was easy. Only at state veterinary centers were the microbiological laboratory wastes after the sterilization initially safe, then it  was shipped with other waste produced by ordinary contractors of urban waste. There was not statistically significant difference between public and private centers in the waste separation and collection. Based on researcher's assessment in this case, all cen- ters had average conditions for garbage col- lection. In all public and private centers, tem- porary storage of waste was unfavorable.   In

this case only the veterinary  administration of the province was in a desirable situation. Also, in all centers, waste produced by ordi- nary trucks without the hazardous waste sign was shipped in an unfavorable situation. The results of this research showed that general management of waste in public veterinary centers is more favorable than private ones (Fig. 1 - 8). Considering the great variety and volume of veterinary centers waste, espe- cially the infectious waste, hazardous waste, the high cost of management of infectious waste, careful and continuous monitoring of the management of this type of waste to pro- vide, maintain and increase the level of staff, other people in the community and the envi- ronment health will be essential. Therefore, the type of veterinary waste management, especially the way of separating hazardous waste from public waste is very important. On the other hand, there is a lack of training of personel, especially service staff, lack of proper supervision over their activities, lack of motivation and some neglect of medical staff in non-infectious waste commixture in waste bags specialized for infectious  waste or vice versa. The reasons are the increase in the percentage of infectious waste compared with the total waste. The type of transport and disposal of veterinary waste is done ordinari- ly and by the contractors of city hall. How- ever, state veterinary centers are required to provide better and higher quality services because of their profitmaking, lack of need for more income and more attention to legal materials. According to factors such as, 1-the use of different colored waste bags for the separation of infectious and non-infectious waste 2- suitable waste storage tanks 3- dai- ly washing and disinfection of tanks 4- the creation of a suitable distance between the temporary storage site and the closest part of

the center 5- more alternation in the collec- tion and transport of waste from the parts to the place of temporary storage until reach- ing the final disposal site 6- more attention   to health issues, have a better relative posi- tion. On the other hand, the flexibility and freedom of managers  of  veterinary  centers in the private sector are likely to attract less attention to waste management and reduce the cost of this important issue. Part of the evaluated cases in this study is consistent with some of the studies in the final  phase  of disposal management for private medical clinics in relation to the release of this waste and the increase of environmental risk and human health (Gulyurt, 2012). The status of waste management in the studied veterinary centers had more unfavorable condition than the status of waste management of the human hospitals reported in Iran, Tabriz University Hospitals, Tehran University of Medical Sci- ences, Shahid Beheshti and North Khorasan, (Dehghani, Azam, Changani, & Dehghani Fard, 2008; Jaafari, Dehghani, Hoseini, & Safari, 2015;  Majlesi,  Alizadeh,  Forutani,  & Gachkar, 2007; Naimi et al., 2015;  Ta- heri, Hamidiyan, & Khazaei, 2013).  Based on the findings of the present study, the type and amount of waste produced by veterinary service centers are not only different in the studied centers, but also somewhat different from those of other countries.  The  reason for this difference is mainly due to various factors such as waste management, type of services provided by the centers, number of active sectors, cultural, economic status  of the community, and so on (Le et al., 2018; Oweis et al., 2005; Tsakona, Anagnostopou- lou, & Gidarakos, 2007).  Failure  to proper- ly implement the rules for the management  of infectious wastes is a major problem for veterinary wastes .As a result, the   challenge