INTRODUCTIO=
N
Law No. 8,080/90 establishes that health i=
s a
human right and a duty of the State, which must guarantee public policies a=
imed
at reducing risks and harms to health, and the environment is one of the
determining and conditioning factors for the disease process(1).
Thus, environmental health is the result of the interaction between society=
and
nature, starting from the generation of waste that can directly affect the
health-disease process and the quality of life of living beings(2).
In Brazil, nearly 79 million tons of Urban
Solid Waste (USW) are generated, with part of it consisting of Health
Services Waste (HSW) and, when its management is inadequate, it characteriz=
es
risks to human and environmental health(3). HSW come from the
provision of health care, from public or private institutions, households a=
nd
facilities that handle these types of waste produced during care(4).
Waste from health servi=
ces
is classified into five groups: group A – infectious;
Group B – chemical; Group C – radioactive;
Group D – common waste; and Group E – sharps<=
sup>(5).
In addition, they present determining factors for exposure to infectious,
chemical and radioactive agents and even sharp objects, which can lead to t=
he
transmission of infectious and contagious diseases by viruses and bacteria,
such as the Human Immunodeficiency Virus (HIV) and the Hepatitis B
and C viruses, among others(6). When the waste produced is not
managed properly, it can result in adverse effects on the population's heal=
th
and on the environment, as it leads to the contamination of environmental
features such as water, soil and air(4).
For management to be
carried out by the health services, it is necessary to resort to the
implementation of public policies that develop actions encouraging educatio=
n,
awareness and social responsibility towards commitment to the environment.
Thus, the objective is to minimize the impacts to environmental health caus=
ed
by incorrect waste disposal(4). Consequently, it is indispensabl=
e to
promote health and preserve the environment. Thus, it is up to the managers=
of
the municipal, state and federal spheres to adopt in practice the functioni=
ng
of the laws and regulations responsible for the natural environment(3)=
.
For this purpose, every health institution must
have a correct management plan for Health Services Waste (MPHSW), which
corresponds to the compatibility of norms related to proper management, from
segregation to final disposal(5). Due to the high danger of some
waste, which is not naturally degradable, awareness raising for a sustainab=
le
environment must be stimulated, corroborating the legislation with the
perspective of reducing the harmful action to the natural environment relat=
ed
to incorrect waste disposal(7).
Health institutions promote exposure to risks to
human health and, consequently, to the natural environment. Nurses are
sensitive to vulnerable needs, playing a fundamental role in sharing their
knowledge for the promotion of health, both human and environmental, as the=
re
is a commitment to the quality of life of individuals as a whole(8).
Environmental problems are correlated with the
evolution of economic and social development over time, leading to
environmental issues that affect health. Thus, for environmental health to =
be
preserved, it is necessary to take actions that reflect positively on the
ecosystem, such as policies to protect and promote environmental and human
health. However, it is indispensable that there is participation of Nursing=
in
the development of care strategies to educate and raise awareness in the
population, so that they maintain sustainable attitudes towards the environ=
ment
since Nursing is able to influence people through education in health(=
9).
Therefore, it is important to emphasize the
importance of knowledge related to the proper management of HSW by Nursing
professionals, as well as sustainability of the environment. For this, the
question raised for the development of this review was as follows: Which are
the contributions of Nursing to sustainability regarding HSW? Therefore, the
objective is to know the contribution of Nursing to environmental
sustainability with a focus on waste from health services.
METHOD
This is a bibliographic
study, of the integrative literature review type, a research method that al=
lows
for the systematic synthesis of diverse clinical evidence, in order to
incorporate scientific results(10). The data were collected in
June 2021 in the Google Scholar database, as the previous search in the
Virtual Health Library (Biblioteca Virtual em Saúde, BVS) did not in=
clude
the subexistential number of articles, giving
preference to Google Scholar.
Descriptors such as
“'Sustainability; Nursing; Waste from Health Services; Environment” were us=
ed,
totaling 2,420 files. For selection, inclusion criteria were establish=
ed,
namely: full texts, last four years (2018 – 2021), title and
abstract. Reviews, theses, dissertations and papers published in events were
excluded. After refining the files, 43 articles were selected for read=
ing
their titles and abstracts. This resulted in a total of 25 articles for
full reading. Of these, 18 were removed after reading their full texts, and
seven publications were chosen for the study, as shown in Figure 1 -
PRISMA flowchart(11).
After analyzing the
studies, preparation of the body of the review was initiated in a synthesiz=
ed
and systematic way, corresponding to the objective proposed by the study. T=
hus,
this discussion is necessary to understand the issues involving Nursing and=
the
environment, as well as the risks exposed to the compromise of environmental
sustainability amid inappropriately disposed health services waste.<=
span
lang=3DEN-US style=3D'font-size:12.0pt;line-height:150%;font-family:"Times =
New Roman",serif'>
DISCUSSION<=
/span>
Scarcely discussed
knowledge about the concept of HSW in the Nursing field of work is pointed =
out.
It is noticeable that there is a limitation of practical and theoretical
knowledge about waste and its management mode. According to the authors(12),
during the training process, the students need to have a broader perspectiv=
e in
relation to the production of HSW, as it is not only limited to hospital ar=
eas,
but also covers health institutions and the environment as a whole. As a
result, education focused on this theme must have a strengthened basis duri=
ng
the academic period, which aims at preservation and at minimizing the risks=
to
environmental health caused by the provision of human care. In this way, at=
the
same time, it highlights the correct form of waste disposal and packaging. =
Lack of knowledge about=
the
correct way to handle waste implies exposure to health risks as a result of=
the
impacts caused to the environment. For this reason, conscious HSW managemen=
t is
fundamental in order to encourage the reduction of infection risks and
preservation of the environment(13). This is where the Management
Plan of Health Services Waste (MPHSW) enters into action, which must
correspond to a set of procedures for correct waste management, in order to
promote the commitment to establish preventive and sustainable ways for the=
environment,
confirming the minimization of impacts to environmental health(14).
Part of the HSW product=
ion
is a consequence of Nursing actions, as these professionals are the ones who
most generate and handle these types of waste during the assistance provide=
d.
As soon as management is properly understood, from segregation to final
disposal, it is emphasized that the nurses' participation in the elaboratio=
n of
the MPHSW is essential for the management of waste from a given health
facility. Lack of this leads to environmental damage due to indiscriminate
disposal into natural resources, as it harms health and environmental
preservation. However, some professionals find it difficult to differentiate
the types of waste, especially neglecting the segregation stage, one of the
most important in proper management(15).
Based on this, the auth=
ors(15)
address that nurses have the power to manage the health services. In additi=
on
to that, the authors attribute limited knowledge regarding adequate managem=
ent
to work overload, lack of discussion in the university and lack of interest=
on the
part of the professionals. However, nearly 54.16% of the nurses interviewed
reported that the segregation stage was performed properly, although 29.16%=
of
them stated they did not handle it correctly. In other words, lack of knowl=
edge
about how to manage waste efficiently reflects in adverse effects on the
environment due to incorrect disposal.
The authors(13)
corroborate this when they state that 60.52% of the professionals are unawa=
re
of the final disposal of HSW, and emphasize that 92.84% are aware of the ri=
sks
inherent to the health of living beings.
Incorrect disposal is
sometimes neglected at the generating source, such as the segregation resul=
ting
from management failures, as not offering an appropriate container for this
destination increases the risk exposure factor to the workers themselves(16).
The same occurs as a result of misappropriation and results in exposure to
hazardous waste, as it is directed to the environment under a load of negat=
ive
effects to the natural resources(17).
Another important findi=
ng
in relation to the interest in complying with the legislation is the propos=
al
of using the 3Rs method, based on waste Reduction, Reuse and Recycling, whi=
ch
is viable during its management for sustainability. Thus, the MPHSW becomes
efficient and sustainable with the environment(18).
Disinformation presents
itself as a contributing factor to the ineffectiveness of proper management=
and
reinforces the perspective of providing, through permanent education, the
provision of qualifications and training for knowledge about correct
management, as an alternative to alleviate these effects generated by
inadequate final waste disposal to the natural environment and to people(17).
Since management is
essential to maintain a sustainable environment, as well as to promote heal=
th,
quality of life and preservation of the environment, the association between
inadequate management and environmental contamination reflects in the sprea=
d of
infectious and contagious diseases. In other words, when the substances com=
ing
from waste without treatment and proper destination may pass through the
natural protection barriers, reach and contaminate the water of superficial=
or
underground places, such as groundwater(3).
It is noticed that prop=
er
management favors the preservation of environmental and human health, as it
contributes to sustainability. Thus, it is through education and legislation
that seeks to initiate programs to minimize waste and its risks that health
professionals become aware(3). The authors(19)
corroborate this line of thought when they denote that environmental issues
must be addressed in health and education institutions in order to reduce t=
he
impacts caused by HSW, and that there is a need to recognize social and
environmental responsibility.
FINAL CONSIDERATIONS
It is shown that knowle=
dge
about the waste from health services needs to be discussed by Nursing, as it
presents weaknesses during the training process and in health institutions,
which is consistent with the lack of encouragement to improve practices for
good management.
The possible consequences caused to
environmental health and to people occur due to inadequate waste packaging,
seen in the professionals' contribution during the MPHSW stages
inappropriately, in the exposure to risk factors.
The need to improve the
Nursing team regarding correct management is thus reinforced, so that they =
can
collaborate in a sustainable way with the environment and health. Therefore,
the search for studies that complement this review is encouraged, with the =
aim
of achieving greater depth on the theme for future researchers.<=
/span>
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21806.
Corresponding Author
Luiz
Fernando Brito da Costa, BR 405, KM 153, Arizona 59900-000 – Pau dos Ferros=
-RN.
Thep=
hone Number: + 55(84) 9 9631-4577, e-mail:
luizfernandubrito@gmail.com.
Submission: 2021-10-12
Approval: 2021-11-30
<=
/o:p>
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