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ar
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[
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–
[
6
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.
Ho
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[
5
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[
1
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[
3
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[
1
1
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1
6
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.
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4
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2
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.
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o
f
wo
r
k
[2
4
]
,
[
25
].
Ma
n
ag
em
en
t
o
f
h
az
a
r
d
o
u
s
an
d
to
x
ic
m
e
d
ical
waste
is
o
n
e
o
f
th
e
m
o
s
t
s
er
io
u
s
p
r
o
b
lem
s
at
th
e
p
r
esen
t
m
o
m
en
t
in
h
ea
lth
f
ac
ilit
ies
s
in
ce
in
f
ec
tio
u
s
m
ed
ical
waste,
h
as
a
h
ig
h
p
o
ten
tial
to
tr
an
s
m
it
co
n
tag
i
o
u
s
d
is
ea
s
es
e
ith
er
th
r
o
u
g
h
d
ir
ec
t
o
r
i
n
d
ir
ec
t
co
n
tact
th
r
o
u
g
h
en
v
ir
o
n
m
en
t
al
m
ed
ia.
Po
llu
tio
n
f
r
o
m
m
ed
ical
waste
ca
n
b
e
m
in
im
ized
with
ef
f
ec
tiv
e
an
d
ef
f
icien
t
p
r
o
ce
s
s
in
g
to
r
ed
u
ce
en
v
ir
o
n
m
en
tal
p
o
llu
tio
n
[
2
0
]
,
[
2
1
]
,
[
2
3
]
,
[
2
6
]
.
I
t
is
im
p
er
ativ
e
to
tak
e
ap
p
r
o
p
r
iate
m
ea
s
u
r
es
to
m
itig
ate
th
e
r
is
k
o
f
r
ap
i
d
tr
an
s
m
is
s
io
n
in
h
o
s
p
itals
,
as
it
is
lin
k
ed
to
t
h
e
m
ed
ical
wast
e
m
an
ag
em
e
n
t
s
y
s
tem
.
Stan
d
a
r
d
izatio
n
an
d
s
tr
ict
im
p
lem
en
tatio
n
o
f
m
e
d
ical
waste
m
an
ag
em
en
t
ar
e
cr
u
cial
f
o
r
co
n
tr
o
llin
g
s
o
u
r
ce
s
o
f
in
f
ec
tio
n
,
p
ar
ticu
lar
ly
in
lig
h
t o
f
th
e
C
OVI
D
-
1
9
p
an
d
e
m
ic
[
2
7
]
–
[
3
0
]
.
Ho
wev
er
,
o
u
r
u
n
d
er
s
tan
d
in
g
o
f
th
e
v
ar
io
u
s
d
eter
m
in
a
n
ts
th
a
t
ag
g
r
a
v
ate
liq
u
i
d
waste
m
an
a
g
em
en
t
in
p
u
b
lic
an
d
p
r
iv
ate
h
o
s
p
itals
in
I
n
d
o
n
esia
is
lim
ited
.
Mo
s
t
o
f
th
e
s
tu
d
ies
r
ev
ea
led
th
ey
ju
s
t
s
p
ea
k
ab
o
u
t
waste
m
an
ag
em
en
t
in
g
e
n
er
al,
n
o
t
o
n
ly
liq
u
id
,
a
n
d
m
in
im
al
d
ata
o
n
p
u
b
lic
h
o
s
p
itals
.
Ma
n
y
ch
allen
g
es
r
elate
d
to
waste
m
an
ag
em
en
t
in
h
o
s
p
itals
ar
e
ca
u
s
ed
b
y
a
lack
o
f
ass
i
s
tan
ce
an
d
a
s
u
p
er
v
is
io
n
s
y
s
tem
r
eg
ar
d
in
g
ef
f
ec
tiv
e
an
d
s
af
e
waste
m
an
ag
em
en
t.
T
h
e
h
o
s
p
ital
m
an
ag
em
en
t
s
h
o
u
ld
estab
lis
h
s
y
s
tem
s
to
en
s
u
r
e
co
m
p
lian
ce
with
n
atio
n
al
leg
i
s
latio
n
o
n
waste
m
an
ag
em
e
n
t
b
y
p
r
o
v
id
i
n
g
ap
p
r
o
p
r
iate
tr
ai
n
in
g
an
d
r
eso
u
r
ce
s
to
all
s
taf
f
m
e
m
b
er
s
.
R
eg
u
l
ar
s
u
p
er
v
is
io
n
o
f
waste
m
an
ag
em
en
t
p
r
ac
tices
is
cr
u
cial
in
p
r
o
m
o
ti
n
g
b
est
p
r
ac
tices
an
d
cr
e
atin
g
a
s
af
e
wo
r
k
in
g
en
v
ir
o
n
m
e
n
t
f
o
r
th
e
s
taf
f
,
v
is
ito
r
s
,
an
d
th
e
en
v
ir
o
n
m
en
t.
C
o
n
s
id
er
in
g
th
at
s
tu
d
ies
h
a
v
e
r
e
p
o
r
te
d
p
o
o
r
waste
m
a
n
ag
em
e
n
t
p
r
ac
tices
d
u
e
to
i
n
s
u
f
f
icien
t
k
n
o
wled
g
e
a
n
d
in
ad
e
q
u
ate
tr
ain
in
g
in
o
th
er
p
ar
ts
o
f
th
e
c
o
u
n
tr
y
,
it
is
im
p
o
r
tan
t
to
d
ev
e
lo
p
a
f
ea
s
ib
le
s
u
p
er
v
is
io
n
tec
h
n
iq
u
e
an
d
t
r
ain
in
g
cu
r
r
icu
lu
m
th
at
co
v
e
r
s
waste
m
an
ag
em
e
n
t
p
r
ac
tices
ap
p
r
o
p
r
iately
in
th
e
h
o
s
p
ital's
waste
m
an
ag
em
en
t
s
y
s
tem
s
.
T
h
is
s
co
p
in
g
r
ev
ie
w
aim
s
to
a
s
s
es
s
an
d
m
ap
th
e
v
ar
io
u
s
d
eter
m
in
a
n
ts
af
f
ec
tin
g
h
o
s
p
ital
liq
u
id
m
ed
ical
waste
m
an
a
g
em
en
t.
T
h
is
s
tu
d
y
p
r
o
v
id
es
im
p
o
r
tan
t
p
r
o
ce
d
u
r
es
f
o
r
co
n
d
u
cti
n
g
r
e
v
iews,
in
clu
d
in
g
th
e
m
eth
o
d
o
f
s
ea
r
ch
in
g
an
d
s
elec
tin
g
ar
ticles an
d
s
tep
s
in
an
aly
zin
g
th
e
ar
ticles o
b
tain
e
d
.
2.
M
E
T
H
O
D
2
.
1
.
Sea
rc
h str
a
t
eg
y
a
nd
s
elec
t
io
n c
rit
er
ia
T
h
r
o
u
g
h
an
an
aly
s
is
o
f
th
e
liter
atu
r
e,
th
is
r
ev
iew
s
o
u
g
h
t
to
id
en
tify
th
e
f
ac
to
r
s
th
at
in
f
lu
en
ce
h
o
s
p
itals
'
h
an
d
lin
g
o
f
h
o
s
p
ital
liq
u
id
m
ed
ical
waste.
T
h
e
r
ev
iew
q
u
esti
o
n
f
o
cu
s
ed
o
n
“Wh
at
wer
e
th
e
d
eter
m
in
an
t
f
ac
t
o
r
s
th
at
co
n
tr
i
b
u
ted
to
m
an
ag
in
g
liq
u
id
m
ed
ical
waste
in
h
o
s
p
itals
in
I
n
d
o
n
esia?
T
h
e
s
tu
d
ied
d
o
m
ain
s
wer
e
liq
u
id
,
s
o
lid
,
m
ed
ical
waste,
an
d
h
o
s
p
itals
in
I
n
d
o
n
esia.
T
h
is
s
co
p
in
g
r
ev
iew
u
s
ed
Go
o
g
le
Sch
o
lar
an
d
Pu
b
Me
d
to
f
in
d
p
o
s
s
ib
le
p
ap
er
s
.
On
ly
o
r
ig
in
a
l
ar
ticles
r
elea
s
ed
b
etwe
en
Au
g
u
s
t
2
0
1
7
an
d
th
e
en
d
o
f
No
v
em
b
er
2
0
2
3
in
b
o
th
I
n
d
o
n
esian
an
d
E
n
g
lis
h
we
r
e
in
clu
d
e
d
in
t
h
e
s
ea
r
ch
p
ar
a
m
eter
s
.
T
o
en
s
u
r
e
r
esear
ch
ac
cu
r
ac
y
,
we
s
p
o
k
e
with
ac
ad
em
ic
lib
r
ar
ian
s
with
ex
p
er
ien
ce
s
co
p
in
g
r
ev
iew
s
tu
d
ies
wh
en
d
ev
elo
p
in
g
o
u
r
s
ea
r
c
h
tech
n
iq
u
e.
T
o
f
i
n
d
m
o
r
e
r
elev
an
t
p
ap
er
s
,
a
m
a
n
u
al
s
ea
r
c
h
o
f
th
e
in
clu
d
ed
s
tu
d
ies'
r
ef
er
en
ce
lis
t
was
d
o
n
e.
I
n
t
h
e
co
u
r
s
e
o
f
citatio
n
c
h
ain
in
g
,
we
lo
o
k
ed
f
o
r
p
o
ten
tially
ac
ce
p
tab
le
m
an
u
s
cr
ip
ts
cited
o
n
Go
o
g
le
Sch
o
lar
.
W
e
also
u
s
ed
th
e
Pro
Qu
est
d
i
s
s
er
tatio
n
an
d
th
esis
d
atab
ase
to
s
ca
n
th
e
g
r
ey
liter
atu
r
e
f
o
r
id
en
tifie
d
u
n
p
u
b
lis
h
ed
m
ater
ial.
T
h
is
s
co
p
in
g
r
ev
iew
co
n
s
id
er
ed
v
ar
io
u
s
p
r
ep
r
in
ted
ar
ticles
s
u
ch
as
m
ed
R
x
iv
.
T
ab
le
1
p
r
esen
ts
th
e
liter
atu
r
e
s
ea
r
ch
th
r
o
u
g
h
t
h
e
d
atab
ase
d
atab
ases
k
ey
wo
r
d
s
Pu
b
Me
d
(
L
iq
u
id
OR
s
o
lid
OR
liq
u
id
waste
O
R
s
o
lid
w
aste
O
R
h
o
s
p
ital
w
aste
OR
h
o
s
p
ital
liq
u
id
waste
OR
h
o
s
p
ital
s
o
lid
waste)
an
d
(
W
aste
m
an
ag
em
e
n
t
OR
h
o
s
p
ital
waste
m
an
ag
em
en
t
OR
h
o
s
p
ital
liq
u
id
waste
m
an
ag
em
e
n
t
OR
h
o
s
p
ital so
lid
waste
m
an
ag
em
en
t)
.
2
.
2
.
Study
s
elec
t
io
n pro
ce
s
s
2
.
2
.
1
.
E
lig
ibi
lity
cr
it
er
ia
Par
ticip
an
t
ty
p
es
wer
e
tak
en
i
n
to
ac
co
u
n
t
f
o
r
all
r
esear
ch
p
r
o
jects
in
I
n
d
o
n
esia
th
at
in
v
o
lv
ed
b
o
th
p
u
b
lic
an
d
p
r
iv
ate
h
o
s
p
itals
.
I
n
ter
v
en
tio
n
ty
p
es:
n
o
t
h
in
g
wa
s
d
o
n
e
in
th
is
r
e
g
ar
d
.
T
h
e
d
eter
m
in
an
t
elem
en
ts
th
at
wer
e
s
u
b
s
tan
tially
in
f
lu
en
cin
g
I
n
d
o
n
esia'
s
h
o
s
p
ital
w
aste
m
an
ag
em
en
t
wer
e
ass
es
s
ed
in
th
is
s
co
p
in
g
r
ev
iew.
T
y
p
es
o
f
o
u
tc
o
m
e
m
ea
s
u
r
es
ar
ticles
an
d
s
tu
d
ies
wer
e
r
ev
i
ewe
d
to
d
eter
m
in
e
wh
eth
er
th
ey
r
e
p
o
r
t
m
an
ag
em
en
t
o
f
h
o
s
p
ital
waste
b
ef
o
r
e
,
d
u
r
in
g
,
o
r
a
f
ter
C
OVI
D
-
1
9
an
d
o
r
m
an
ag
e
m
en
t
o
f
h
o
s
p
ital
liq
u
id
waste
b
ef
o
r
e,
d
u
r
in
g
,
o
r
a
f
ter
C
OVI
D
-
1
9
.
Stu
d
ies
also
in
clu
d
ed
d
ata
th
at
ca
n
b
e
ca
lcu
lated
s
tatis
tically
if
th
ey
r
ep
o
r
t it.
L
etter
s
,
co
m
m
en
ts
,
c
ase
r
ep
o
r
ts
,
o
r
r
ev
iews we
r
e
e
x
clu
d
ed
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
n
fo
r
min
g
co
mp
lia
n
ce
fa
cto
r
s
r
eg
a
r
d
in
g
h
o
s
p
ita
ls
w
a
s
te
ma
n
a
g
eme
n
t
…
(
Ma
r
ku
s
K
a
b
a
n
)
221
T
y
p
es
o
f
s
tu
d
y
o
b
s
er
v
atio
n
al
an
d
lo
n
g
itu
d
in
al
s
tu
d
y
d
esig
n
s
in
v
o
lv
in
g
h
o
s
p
ital
waste
m
an
ag
em
en
t
in
I
n
d
o
n
esia
wer
e
tak
e
n
in
t
o
co
n
s
id
er
atio
n
in
t
h
e
ev
al
u
atio
n
.
T
h
e
an
aly
s
is
was
n
o
t
s
u
p
p
o
r
ted
b
y
an
y
q
u
alitativ
e
s
tu
d
ies
th
at
we
i
n
clu
d
ed
.
T
wo
s
tag
es
o
f
th
e
r
ev
iew
p
r
o
ce
s
s
wer
e
ca
r
r
ied
o
u
t.
Fo
llo
win
g
th
e
in
clu
s
io
n
an
d
ex
clu
s
io
n
cr
iter
i
a,
th
e
two
r
ev
iewe
r
s
ev
alu
ated
th
e
liter
atu
r
e
in
th
e
f
ir
s
t
s
tag
e
b
ased
o
n
titl
e
an
d
ab
s
tr
ac
t.
E
v
er
y
ar
ticle,
in
clu
d
i
n
g
f
u
ll
tex
t
v
e
r
s
io
n
s
,
th
at
m
ad
e
it
b
ey
o
n
d
t
h
e
f
ir
s
t
r
o
u
n
d
was
ex
am
in
ed
ag
ai
n
in
th
e
s
ec
o
n
d
.
T
h
e
ac
q
u
ir
e
d
ar
ti
cles
f
ell
in
to
o
n
e
o
f
t
h
r
ee
ca
te
g
o
r
ies:
"in
clu
d
ed
,
"
"e
x
clu
d
e
d
,
"
o
r
"u
n
ce
r
tain
.
"
I
f
th
er
e
was
d
is
ag
r
ee
m
en
t
b
etw
ee
n
th
e
two
r
e
v
iewe
r
s
,
a
th
ir
d
r
ev
iewe
r
was
co
n
s
u
lted
.
T
h
e
in
clu
s
io
n
cr
iter
ia
wer
e
q
u
an
titativ
e
s
tu
d
y
,
h
o
s
p
i
tal
liq
u
id
waste,
th
e
h
o
s
p
ital
lo
ca
ted
in
I
n
d
o
n
esia,
an
d
ar
ticl
es
wr
itten
b
etwe
en
2
0
1
7
a
n
d
2
0
2
3
in
E
n
g
lis
h
an
d
I
n
d
o
n
esian
.
Me
an
wh
ile,
th
e
ex
clu
s
io
n
cr
iter
ia
wer
e
q
u
a
litativ
e
s
tu
d
ies
an
d
ar
ticles wr
itten
b
ef
o
r
e
2
0
1
7
.
T
ab
le
1
.
L
iter
atu
r
e
s
ea
r
ch
es th
r
o
u
g
h
th
e
d
ata
b
ase
2
.
2
.
2
.
Da
t
a
ex
t
r
a
ct
io
n
Nu
m
er
o
u
s
f
ac
to
r
s
wer
e
ex
tr
a
cted
f
r
o
m
th
e
d
ata,
in
clu
d
in
g
th
e
f
o
llo
win
g
:
au
th
o
r
,
p
u
b
lic
atio
n
y
ea
r
,
s
tu
d
y
s
ite,
d
esig
n
,
an
d
aim
s
; p
ar
ticip
an
t; o
u
tco
m
e
m
ea
s
u
r
e
m
en
t; m
ea
s
u
r
em
en
t scale
u
tili
ze
d
; d
ata
q
u
ality
; a
n
d
au
th
o
r
s
u
g
g
esti
o
n
.
B
ased
o
n
i
n
ter
n
atio
n
al
p
u
b
licatio
n
s
,
t
h
e
d
ata
ex
tr
ac
tio
n
was
co
m
p
lete
d
.
Fil
ter
in
g
jo
u
r
n
als
d
ea
lin
g
with
h
o
s
p
ital
waste
m
an
ag
em
en
t
was
d
o
n
e
a
f
ter
th
e
in
itial
r
o
u
n
d
o
f
d
ata
ex
tr
ac
ti
o
n
was
co
m
p
leted
.
T
h
e
h
an
d
lin
g
o
f
h
o
s
p
ital w
ast
e
in
I
n
d
o
n
esia is th
e
s
u
b
ject
o
f
th
e
n
ex
t
p
h
ase,
at
th
e
en
d
.
2
.
2
.
3
.
Q
ua
lit
y
a
s
s
ess
m
ent
T
h
is
s
co
p
in
g
r
ev
iew'
s
r
esear
ch
ar
ticles'
r
is
k
o
f
b
ias
was
ev
alu
ated
b
y
f
o
u
r
in
v
esti
g
ato
r
s
o
n
t
h
eir
o
w
n
.
T
h
e
r
ev
iew
p
r
o
ce
d
u
r
e
u
s
ed
s
ev
er
al
cr
itical
ev
alu
atio
n
to
o
ls
,
s
u
ch
as
th
e
C
AS
P
ch
ec
k
lis
t
f
o
r
o
b
s
er
v
atio
n
a
l
r
esear
ch
,
d
ep
en
d
in
g
o
n
th
e
ty
p
e
o
f
s
tu
d
y
.
T
h
e
n
ex
t
s
tep
is
cr
ea
ted
u
s
in
g
th
e
q
u
ality
ev
al
u
atio
n
r
esu
lts
as
a
g
u
id
e.
2.2.4.
Da
t
a
syn
t
hes
i
s
T
h
e
r
esu
lts
wer
e
s
y
n
th
esized
n
ar
r
ativ
el
y
u
s
in
g
t
h
e
r
etr
i
ev
ed
d
ata.
B
ased
o
n
s
tu
d
y
q
u
esti
o
n
s
,
d
eter
m
in
an
t
f
ac
to
r
s
,
r
esu
lt
k
in
d
s
,
an
d
h
ea
lth
im
p
licatio
n
s
,
th
e
d
ata
was
ca
teg
o
r
ized
.
A
n
ar
r
ativ
e
was
u
s
ed
to
p
r
esen
t
th
e
o
u
tco
m
es
o
f
th
e
q
u
an
titativ
e
d
ata.
I
n
o
r
d
er
to
co
n
f
ir
m
th
e
an
aly
s
is
r
esu
lts
,
a
te
am
m
ee
tin
g
will
b
e
h
eld
wh
en
t
h
e
d
ata
an
al
y
s
is
is
p
r
im
ar
ily
co
m
p
leted
b
y
f
o
u
r
r
ev
iewe
r
s
(
MK
,
T
R
S,
S,
an
d
PAP).
3.
RE
SU
L
T
S
AND
D
I
SCU
SS
I
O
N
3
.
1
.
L
it
er
a
t
ure
s
ea
rc
h
A
s
ea
r
ch
o
f
an
elec
tr
o
n
ic
d
atab
ase
tu
r
n
ed
u
p
s
ev
en
ty
a
r
ticles.
E
v
er
y
p
ap
er
was
lo
ca
ted
u
s
in
g
Pu
b
Me
d
an
d
Go
o
g
le
Sch
o
lar
.
Af
ter
th
e
f
ir
s
t
r
o
u
n
d
o
f
ex
clu
s
i
o
n
s
,
eig
h
t
d
u
p
licates
wer
e
eli
m
in
ated
,
leav
i
n
g
6
2
s
o
u
r
ce
s
f
o
r
th
e
titl
e
an
d
ab
s
tr
ac
t
s
cr
ee
n
in
g
.
T
h
e
5
4
p
u
b
lica
tio
n
s
in
all
we
r
e
d
ee
m
ed
p
o
s
s
ib
ly
r
elev
an
t;
th
e
i
n
clu
s
io
n
an
d
ex
clu
s
io
n
cr
iter
ia
wer
e
ex
am
in
e
d
in
co
n
j
u
n
c
tio
n
with
th
e
f
u
ll
tex
ts
to
d
et
er
m
in
e
elig
ib
ilit
y
.
Af
ter
b
ein
g
s
elec
ted
f
o
r
th
is
s
co
p
in
g
r
ev
iew,
s
ix
p
ap
er
s
wer
e
lef
t
f
o
r
s
y
n
th
esis
.
T
h
e
p
r
o
ce
d
u
r
e
o
f
s
elec
tin
g
s
tu
d
ies is
o
u
tlin
ed
in
Fig
u
r
e
1
o
f
th
e
P
R
I
SMA
f
lo
wch
ar
t [
3
1
]
.
3
.
2
.
Co
m
po
nent
o
f
ho
s
pita
l
-
ba
s
ed
-
wa
s
t
e
m
a
na
g
em
ent
Six
ar
ticles
r
ef
lect
o
n
waste
m
an
ag
em
en
t
in
h
o
s
p
itals
[
3
2
]
–
[
3
7
]
.
All
o
f
th
ese
ar
ticles
ar
e
q
u
an
titativ
e
an
d
a
r
e
c
o
n
d
u
cted
in
a
v
ar
iet
y
o
f
I
n
d
o
n
esian
co
n
tex
ts
,
in
c
lu
d
in
g
p
r
iv
ate
h
o
s
p
i
tals
[
3
3
]
,
[
3
5
]
,
[
3
6
]
,
p
u
b
li
c
h
o
s
p
itals
[
3
4
]
,
[
3
7
]
,
an
d
p
r
i
v
ate
an
d
p
u
b
lic
h
o
s
p
itals
[
3
2
]
.
Mo
s
t
ar
ticles
ex
am
in
e
v
ar
io
u
s
ca
teg
o
r
ies
o
f
h
o
s
p
ital
waste
in
co
n
ju
n
ctio
n
with
th
e
r
eg
u
latio
n
.
Six
ar
ticles
ex
am
in
ed
s
p
ec
if
ic
c
ateg
o
r
ies
o
f
waste
m
an
ag
em
en
t:
liq
u
id
an
d
s
o
lid
waste
[
3
2
]
,
[
3
6
]
,
[
3
7
]
,
liq
u
id
[
3
3
]
,
an
d
s
o
lid
[
3
4
]
,
[
3
5
]
.
T
h
e
s
e
ar
ticles
ex
p
lo
r
e
waste
m
an
ag
em
en
t
in
h
o
s
p
ital
s
an
d
d
o
n
o
t
f
o
c
u
s
o
n
p
u
b
lic
an
d
h
ea
lth
s
er
v
ices
o
r
b
lo
c
k
c
h
ain
s
r
eg
a
r
d
in
g
th
e
in
clu
d
ed
waste
m
an
ag
e
m
en
t i
n
h
o
s
p
itals
.
D
a
t
a
b
a
s
e
s
K
e
y
w
o
r
d
s
P
u
b
m
e
d
L
i
q
u
i
d
O
R
S
o
l
i
d
O
R
L
i
q
u
i
d
w
a
st
e
O
R
so
l
i
d
w
a
st
e
O
R
H
o
s
p
i
t
a
l
w
a
s
t
e
O
R
H
o
sp
i
t
a
l
l
i
q
u
i
d
w
a
s
t
e
O
R
H
o
s
p
i
t
a
l
so
l
i
d
w
a
s
t
e
)
AN
D
(
W
a
st
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
s
p
i
t
a
l
w
a
st
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
sp
i
t
a
l
l
i
q
u
i
d
w
a
s
t
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
s
p
i
t
a
l
s
o
l
i
d
w
a
s
t
e
m
a
n
a
g
e
m
e
n
t
)
G
o
o
g
l
e
S
c
h
o
l
a
r
L
i
q
u
i
d
O
R
S
o
l
i
d
O
R
L
i
q
u
i
d
w
a
st
e
O
R
so
l
i
d
w
a
st
e
O
R
H
o
s
p
i
t
a
l
w
a
s
t
e
O
R
H
o
sp
i
t
a
l
l
i
q
u
i
d
w
a
s
t
e
O
R
H
o
s
p
i
t
a
l
so
l
i
d
w
a
s
t
e
)
AN
D
(
W
a
st
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
s
p
i
t
a
l
w
a
st
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
sp
i
t
a
l
l
i
q
u
i
d
w
a
s
t
e
m
a
n
a
g
e
m
e
n
t
O
R
H
o
s
p
i
t
a
l
s
o
l
i
d
w
a
s
t
e
m
a
n
a
g
e
m
e
n
t
)
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
2
1
9
-
226
222
3
.
3
.
Reg
ula
t
io
n
o
f
wa
s
t
e
m
a
na
g
em
ent
in ho
s
pita
ls
R
u
les
g
o
v
er
n
in
g
waste
p
r
o
ce
s
s
in
g
ar
e
co
v
er
ed
in
th
r
ee
ar
tic
les
[
3
2
]
,
[
3
3
]
,
an
d
[
3
5
]
.
T
h
e
Min
is
ter
o
f
Hea
lth
's
R
eg
u
latio
n
No
.
1
2
0
4
f
r
o
m
2
0
0
4
[
3
6
]
s
er
v
es
as
th
e
g
en
er
al
p
r
i
n
cip
les
f
o
r
h
o
s
p
ital
waste
r
eg
u
latio
n
s
.
R
eg
u
latio
n
s
No
.
P.6
8
/ME
NL
HK/Setjen
/KUM
.
I
/8
/2
0
1
6
b
y
t
h
e
m
in
is
ter
o
f
en
v
ir
o
n
m
en
t a
n
d
f
o
r
estry
r
e
g
ar
d
in
g
th
e
h
o
s
p
ital
liq
u
id
wastewate
r
q
u
ality
s
tan
d
ar
d
s
an
d
R
eg
u
la
tio
n
Nu
m
b
er
7
o
f
2
0
1
9
b
y
t
h
e
m
in
is
ter
o
f
h
ea
lth
r
eg
ar
d
in
g
th
e
h
o
s
p
ital
en
v
ir
o
n
m
en
tal
h
ea
lth
to
th
e
I
m
p
lem
e
n
tatio
n
o
f
Saf
eg
u
a
r
d
in
g
L
iq
u
i
d
W
aste
[
3
2
]
,
[
3
3
]
.
T
h
e
h
o
s
p
ital
waste
m
an
ag
em
en
t
o
u
tco
m
e
an
d
th
e
u
s
e
o
f
s
tan
d
ar
d
o
p
er
atin
g
p
r
o
ce
d
u
r
e
s
ar
e
th
e
elem
en
ts
g
o
v
er
n
ed
o
r
ad
h
e
r
ed
to
b
y
th
e
r
eg
u
latio
n
s
.
A
f
ew
o
f
th
e
r
e
g
u
l
atio
n
s
'
im
p
lem
en
tatio
n
f
laws,
lik
e
m
an
ag
em
e
n
t'
s
lack
o
f
d
ed
icatio
n
a
n
d
f
o
cu
s
o
n
waste
m
an
ag
em
en
t
o
f
f
icer
s
,
h
av
e
an
im
p
ac
t
o
n
th
e
ef
f
icac
y
an
d
ef
f
icien
c
y
o
f
waste
m
an
ag
em
en
t
o
u
tc
o
m
es
[
3
3
]
.
W
e
d
ec
i
d
ed
o
n
s
ix
h
o
s
p
ital
waste
m
an
ag
em
e
n
t
r
e
g
u
la
tio
n
s
f
r
o
m
1
9
9
5
to
2
0
1
9
[
38
]
–
[
4
3
]
.
All
o
f
th
ese
r
eg
u
l
atio
n
s
ar
e
p
r
o
d
u
ce
d
at
th
e
n
atio
n
al
lev
el.
T
h
e
r
esu
m
e
o
f
th
ese
r
eg
u
latio
n
s
is
p
r
esen
ted
in
T
a
b
le
2
.
Fig
u
r
e
1
.
PR
I
SMA
f
lo
w
illu
s
tr
atin
g
s
tu
d
y
/ar
ticle
in
clu
d
e
d
[
3
1
]
T
ab
le
2
.
R
esu
m
e
th
e
r
e
g
u
latio
n
s
r
eg
ar
d
in
g
h
o
s
p
ital w
aste m
an
ag
em
en
t [
3
8
]
–
[
4
3
]
R
e
g
u
l
a
t
i
ons
Le
v
e
l
s
C
o
m
p
o
n
e
n
t
R
e
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
st
e
r
o
f
E
n
v
i
r
o
n
men
t
a
n
d
F
o
r
e
st
r
y
N
o
.
P
.
6
8
/
M
EN
LH
K
/
S
e
t
j
e
n
/
K
U
M
.
I
/
8
/
2
0
1
6
N
a
t
i
o
n
a
l
D
o
mes
t
i
c
w
a
s
t
e
w
a
t
e
r
q
u
a
l
i
t
y
s
t
a
n
d
a
r
d
s
R
e
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
st
e
r
o
f
E
n
v
i
r
o
n
men
t
N
o
.
P
.
5
6
/
me
n
l
h
k
/
s
e
t
j
e
n
/
k
u
m.
1
/
4
/
2
0
1
5
N
a
t
i
o
n
a
l
P
r
o
c
e
d
u
r
e
s
a
n
d
t
e
c
h
n
i
c
a
l
r
e
q
u
i
r
e
m
e
n
t
s fo
r
m
a
n
a
g
e
me
n
t
o
f
h
a
z
a
r
d
o
u
s a
n
d
t
o
x
i
c
w
a
s
t
e
f
r
o
m
h
e
a
l
t
h
ser
v
i
c
e
f
a
c
i
l
i
t
i
e
s
Le
t
t
e
r
o
f
t
h
e
M
i
n
i
s
t
e
r
o
f
E
n
v
i
r
o
n
m
e
n
t
a
n
d
F
o
r
e
s
t
r
y
N
o
.
S
E.
3
/
M
EN
LH
K
/
P
S
L
B
3
/
P
LB
.
3
/
3
/
2
0
2
1
N
a
t
i
o
n
a
l
M
a
n
a
g
e
m
e
n
t
o
f
B
3
W
a
s
t
e
a
n
d
W
a
st
e
f
r
o
m
(
C
o
v
i
d
-
1
9
)
R
e
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
st
e
r
o
f
H
e
a
l
t
h
N
o
.
1
2
0
4
i
n
2
0
0
4
N
a
t
i
o
n
a
l
H
o
sp
i
t
a
l
e
n
v
i
r
o
n
me
n
t
a
l
h
e
a
l
t
h
r
e
q
u
i
r
e
men
t
s
R
e
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
st
e
r
o
f
H
e
a
l
t
h
N
u
mb
e
r
7
o
f
2
0
1
9
N
a
t
i
o
n
a
l
H
o
sp
i
t
a
l
e
n
v
i
r
o
n
me
n
t
a
l
h
e
a
l
t
h
R
e
g
u
l
a
t
i
o
n
o
f
t
h
e
M
i
n
i
st
e
r
o
f
E
n
v
i
r
o
n
men
t
N
o
.
5
8
/
M
EN
LH
/
1
2
/
1
9
9
5
N
a
t
i
o
n
a
l
S
t
a
n
d
a
r
d
s
o
f
l
i
q
u
i
d
w
a
s
t
e
f
o
r
h
o
s
p
i
t
a
l
a
c
t
i
v
i
t
i
e
s
3
.
4
.
F
a
ct
o
rs r
ela
t
ed
t
o
co
m
p
lia
nce
wit
h wa
s
t
e
m
a
na
g
e
m
e
nt
in ho
s
pita
ls
I
t
was
n
ec
ess
ar
y
to
in
cr
ea
s
e
t
h
e
p
er
ce
n
tag
e
o
f
h
o
s
p
itals
r
ep
o
r
tin
g
th
eir
h
o
s
p
ital
waste
m
an
ag
em
en
t
ac
tiv
ity
o
n
a
r
eg
u
lar
b
asis
f
r
o
m
2
0
1
9
to
2
0
2
0
to
ju
s
t
1
2
%.
Ho
s
p
ital
waste
m
an
ag
em
en
t
c
o
m
p
lian
ce
r
o
s
e
f
r
o
m
8
2
%
to
8
6
%
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
an
d
em
ic,
ac
c
o
r
d
in
g
t
o
r
esear
ch
b
y
Pu
tr
i
et
a
l.
[
3
2
]
.
Prio
r
to
t
h
e
2
0
1
9
C
OVI
D
-
1
9
p
an
d
em
ic,
h
o
s
p
it
als
in
I
n
d
o
n
esia
h
a
v
e
to
co
m
p
ly
with
h
o
s
p
ital
waste
m
a
n
ag
em
en
t
s
tan
d
a
r
d
s
b
ased
o
n
t
h
e
av
ailab
ilit
y
o
f
en
v
ir
o
n
m
en
tal
d
o
cu
m
en
ts
an
d
e
n
v
ir
o
n
m
en
tal
h
ea
lth
u
n
its
.
B
ec
au
s
e
th
e
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
I
n
fo
r
min
g
co
mp
lia
n
ce
fa
cto
r
s
r
eg
a
r
d
in
g
h
o
s
p
ita
ls
w
a
s
te
ma
n
a
g
eme
n
t
…
(
Ma
r
ku
s
K
a
b
a
n
)
223
av
ailab
il
ity
o
f
e
n
v
ir
o
n
m
en
tal
h
ea
lth
u
n
its
af
f
ec
ted
th
e
lev
el
o
f
c
o
m
p
lian
ce
in
b
o
th
y
ea
r
s
,
th
e
av
ailab
ilit
y
o
f
en
v
ir
o
n
m
en
tal
h
ea
lth
u
n
its
was th
e
s
o
le
f
ac
to
r
th
at
m
atter
e
d
d
u
r
in
g
th
e
C
OVI
D
-
1
9
p
a
n
d
em
ic
in
2
0
2
0
[
3
2
]
.
On
ly
o
n
e
o
f
s
ix
ar
ticles
d
is
cu
s
s
es
th
e
s
u
p
er
v
is
io
n
o
f
h
o
s
p
ital
waste
m
an
ag
em
e
n
t.
T
h
e
im
p
o
r
tan
ce
o
f
s
u
p
er
v
is
io
n
is
b
ec
au
s
e
th
at
is
a
p
r
o
ce
s
s
f
o
r
im
p
lem
e
n
tin
g
th
e
d
esk
j
o
b
,
e
v
alu
atin
g
,
an
d
co
r
r
ec
tin
g
to
im
p
lem
en
t
th
e
wo
r
k
ac
co
r
d
in
g
to
th
e
o
r
ig
in
al
p
la
n
.
On
e
o
f
th
e
m
o
s
t
ch
allen
g
in
g
task
s
is
h
az
ar
d
o
u
s
an
d
to
x
ic
m
ater
ials
waste
m
an
ag
em
en
t,
th
er
ef
o
r
e
s
u
p
er
v
is
io
n
n
ee
d
s
t
o
b
e
g
iv
e
n
g
r
ea
t
co
n
s
id
er
atio
n
.
Activ
ities
r
elate
d
to
d
y
n
am
ic
m
o
n
ito
r
in
g
s
h
o
u
ld
tak
e
s
er
io
u
s
ly
th
e
cu
r
r
en
t
s
tate
o
f
h
az
ar
d
o
u
s
an
d
to
x
ic
m
ate
r
ials
waste
is
s
u
es.
An
in
cr
ea
s
e
in
th
e
in
te
n
s
ity
o
f
wast
e
p
r
o
ce
s
s
in
g
co
u
n
ter
ac
ts
t
h
e
r
is
e
in
waste
g
en
er
ated
[
4
4
]
.
3
.
5
.
Dis
cus
s
io
n
Me
d
ical
waste
p
o
s
e
s
n
u
m
er
o
u
s
th
r
ea
ts
to
th
e
h
ea
lth
o
f
e
v
er
y
o
n
e,
in
clu
d
in
g
p
atien
ts
,
h
ea
lth
ca
r
e
p
er
s
o
n
n
el,
an
d
th
e
co
m
m
u
n
i
ty
,
s
o
ad
d
r
ess
in
g
it
in
h
ea
lth
ca
r
e
in
s
titu
tio
n
s
is
e
s
s
en
ti
al.
Me
d
ical
wast
e
m
an
ag
em
en
t
h
as
an
ef
f
ec
t
o
n
th
e
en
v
ir
o
n
m
e
n
t
in
a
n
u
m
b
e
r
o
f
way
s
,
s
u
c
h
as
a
d
ec
r
ea
s
e
in
en
v
ir
o
n
m
e
n
tal
q
u
ality
th
at
ca
n
in
ter
f
er
e
with
an
d
h
ar
m
p
eo
p
le'
s
h
ea
lth
wh
o
liv
e
in
s
u
r
r
o
u
n
d
i
n
g
ar
ea
s
o
f
h
ea
lth
ca
r
e
f
ac
ilit
ies
an
d
o
u
ts
id
e
o
f
c
o
m
m
u
n
itie
s
,
as
well
as
th
e
em
e
r
g
en
ce
o
f
o
cc
u
p
atio
n
al
h
ea
lth
is
s
u
es
in
th
e
f
o
r
m
o
f
f
o
r
m
al
o
cc
u
p
atio
n
al
d
is
ea
s
es
b
r
o
u
g
h
t
o
n
b
y
in
f
ec
tio
u
s
,
s
h
ar
p
m
e
d
ical
waste.
C
h
em
ical
-
co
n
tain
in
g
o
b
jects
p
o
s
e
a
s
ig
n
if
ican
t
d
an
g
er
o
f
s
p
r
ea
d
in
g
in
f
ec
tio
n
s
lik
e
HI
V
an
d
Hep
atitis
B
,
s
u
c
h
as
n
ee
d
lest
ick
in
ju
r
ies
f
r
o
m
u
s
ed
o
r
u
n
s
ter
ile
n
ee
d
les [
4
5
]
,
[
4
6
]
.
Ho
s
p
ital
waste
m
an
ag
em
en
t
n
ee
d
s
to
k
n
o
w
th
e
ty
p
e
o
f
h
o
s
p
ital
waste,
th
e
r
eg
u
latio
n
s
,
an
d
co
m
p
lian
ce
with
h
o
s
p
ital
waste
m
an
ag
em
en
t.
Gen
er
ally
,
th
er
e
ar
e
two
ty
p
es
o
f
h
o
s
p
ital
waste:
liq
u
i
d
an
d
s
o
lid
.
W
e
n
ee
d
a
was
te
wate
r
tr
ea
tm
en
t
p
lan
t
(
W
W
T
P)
f
o
r
l
iq
u
id
to
r
ed
u
ce
th
e
q
u
an
tity
o
f
in
f
ec
tio
u
s
m
ater
ial
an
d
m
in
im
ize
th
e
s
p
r
ea
d
o
f
m
icr
o
o
r
g
a
n
is
m
s
[
3
3
]
.
T
h
e
s
o
lid
waste
n
ee
d
s
an
au
to
clav
e
o
r
an
in
cin
er
ato
r
[
3
6
]
,
[
3
7
]
.
T
h
e
p
r
in
cip
les
o
f
B
3
waste
m
an
ag
em
en
t
(
d
ir
ec
to
r
ate
o
f
en
v
ir
o
n
m
en
tal
h
ea
lth
,
d
ir
ec
to
r
ate
g
en
er
al
o
f
p
u
b
lic
h
ea
lth
)
co
n
s
is
t
o
f
,
f
ir
s
t,
all
waste
p
r
o
d
u
ce
r
s
ar
e
leg
ally
an
d
f
i
n
an
cially
r
esp
o
n
s
ib
le
f
o
r
u
s
in
g
waste
m
an
ag
em
en
t,
wh
ich
is
s
af
e
an
d
en
v
ir
o
n
m
en
tally
f
r
ien
d
l
y
.
S
ec
o
n
d
ly
,
in
th
e
p
r
in
cip
le
o
f
v
i
g
ilan
ce
,
th
o
s
e
wh
o
h
an
d
le
o
r
m
a
n
ag
e
eth
ically
ar
e
r
esp
o
n
s
ib
le
f
o
r
ex
er
cisi
n
g
h
i
g
h
v
ig
ilan
ce
.
T
h
ir
d
,
k
ey
p
r
in
c
ip
les
g
o
v
er
n
h
ea
lth
p
r
o
tectio
n
an
d
s
af
ety
th
r
o
u
g
h
h
an
d
lin
g
e
f
f
o
r
ts
as
q
u
ick
ly
as
p
o
s
s
ib
le,
ass
u
m
in
g
th
at
th
e
r
is
k
s
th
at
m
ay
o
cc
u
r
ar
e
s
u
f
f
icien
tly
s
ig
n
if
ica
n
t.
Fo
u
r
th
,
th
e
p
r
in
cip
le
o
f
p
r
o
x
im
ity
in
h
a
n
d
lin
g
h
az
ar
d
o
u
s
waste
m
in
im
izes
tr
an
s
f
er
r
is
k
s
[
4
7
]
,
[
4
8
]
.
T
h
e
r
eq
u
ir
em
en
t
to
in
cr
ea
s
e
h
o
s
p
ital
co
m
p
lian
ce
with
r
e
p
o
r
tin
g
o
f
h
o
s
p
ital
waste
m
an
ag
em
en
t
(
HW
M)
o
p
er
atio
n
s
b
y
ass
ig
n
in
g
p
e
r
s
o
n
n
e
l
with
th
e
n
ec
ess
ar
y
tr
ain
in
g
in
d
ata
r
ec
o
r
d
i
n
g
,
r
ep
o
r
ti
n
g
,
a
n
d
s
u
b
m
is
s
io
n
.
I
t's
cr
u
cial
to
ap
p
l
y
ad
m
in
is
tr
ativ
e
co
n
s
eq
u
en
ce
s
,
s
u
ch
as f
in
es,
r
eg
u
latio
n
s
f
r
o
m
th
e
g
o
v
er
n
m
e
n
t,
an
d
wr
itten
aler
ts
,
to
h
o
s
p
itals
th
at
f
ail
to
d
is
clo
s
e
th
eir
h
o
s
p
ital
waste
m
an
ag
em
en
t
o
p
er
at
io
n
s
[
3
2
]
.
H
o
s
p
ital
waste
m
an
ag
em
en
t
r
eq
u
ir
es
s
u
p
er
v
is
io
n
b
ec
au
s
e
th
e
s
y
s
tem
is
g
etti
n
g
b
etter
.
On
th
e
o
th
er
h
an
d
,
in
th
e
ab
s
en
ce
o
f
o
v
er
s
ig
h
t,
waste
m
an
ag
em
en
t
will
d
ec
r
ea
s
e.
T
h
is
s
tu
d
y
s
u
p
p
o
r
ts
o
th
er
s
tu
d
ies
th
at
f
o
u
n
d
th
at,
ac
co
r
d
in
g
to
[
3
7
]
,
th
e
p
u
b
lic
h
o
s
p
ital in
Pelalawa
n
r
eg
en
cy
was m
o
n
ito
r
in
g
th
e
m
an
ag
e
m
en
t o
f
m
e
d
ical
waste
o
f
h
az
a
r
d
o
u
s
an
d
to
x
ic
m
ater
i
als
u
s
in
g
th
r
ee
in
d
icato
r
s
:
estab
lis
h
in
g
m
ea
s
u
r
in
g
d
ev
ices
(
s
tan
d
ar
d
s
)
,
ca
r
r
y
in
g
o
u
t
ass
ess
m
en
ts
,
an
d
im
p
lem
en
tin
g
co
r
r
ec
ti
v
e
m
ea
s
u
r
es.
Ho
wev
er
,
th
er
e
ar
e
s
till
wea
k
n
ess
es
in
th
is
s
y
s
tem
,
m
ea
n
in
g
th
at
th
e
s
u
p
er
v
is
io
n
b
ein
g
p
r
o
v
id
ed
is
n
o
t
id
ea
l.
T
h
e
s
m
all
am
o
u
n
t
o
f
f
u
n
d
i
n
g
th
at
was
av
ailab
le
f
o
r
h
is
s
tu
d
y
,
th
e
lack
o
f
p
er
s
o
n
n
el
s
k
illed
ab
o
u
t
en
v
i
r
o
n
m
e
n
ta
l
laws
an
d
r
eg
u
latio
n
s
to
o
v
er
s
ee
m
ed
ical
waste,
an
d
th
e
lack
o
f
p
u
b
lic
awa
r
en
ess
r
eg
ar
d
in
g
th
e
p
r
o
ce
s
s
f
o
r
m
ak
in
g
co
m
p
lain
ts
in
th
e
e
v
e
n
t
o
f
p
o
llu
tio
n
ar
e
s
o
m
e
o
f
th
e
c
h
allen
g
es h
e
f
ac
e
d
[
4
9
]
.
Su
p
p
o
r
tiv
e
s
u
p
er
v
is
io
n
is
a
n
e
w
s
tr
ateg
y
th
at
r
esear
c
h
s
tu
d
ie
s
an
d
p
r
o
g
r
a
m
ass
ess
m
en
ts
r
ec
o
m
m
en
d
to
m
ak
e
s
u
p
er
v
is
io
n
m
o
r
e
f
av
o
r
ab
le
to
im
p
r
o
v
em
en
ts
in
h
e
alth
wo
r
k
er
p
er
f
o
r
m
a
n
ce
.
Su
p
p
o
r
tiv
e
s
u
p
e
r
v
i
s
io
n
b
r
o
ad
e
n
s
th
e
r
an
g
e
o
f
s
u
p
er
v
is
io
n
tech
n
iq
u
es
b
y
in
teg
r
atin
g
p
ee
r
an
d
s
elf
ev
alu
atio
n
s
as
well
as
co
m
m
u
n
ity
f
ee
d
b
ac
k
.
W
ith
s
u
p
p
o
r
tiv
e
s
u
p
er
v
is
io
n
,
th
e
wo
r
k
f
o
r
ce
as
a
wh
o
le
b
ec
o
m
es
th
e
f
o
ca
l
p
o
in
t
o
f
s
u
p
e
r
v
is
o
r
y
ac
tiv
ities
in
s
tead
o
f
ju
s
t
o
n
e
o
f
f
icial.
Ma
n
y
p
ar
ties
,
in
clu
d
in
g
p
ee
r
s
,
h
ea
lth
ca
r
e
p
r
o
v
i
d
er
s
,
an
d
f
o
r
m
ally
r
ec
o
g
n
ized
s
u
p
er
v
is
o
r
s
as
well
as
in
f
o
r
m
al
s
u
p
e
r
v
is
o
r
s
,
ap
p
ly
a
c
r
u
cial
id
ea
i
n
h
elp
f
u
l
s
u
p
er
v
is
io
n
.
B
y
en
h
an
cin
g
co
m
m
u
n
icatio
n
,
e
m
p
h
asizin
g
p
r
o
b
lem
-
s
o
lv
in
g
,
en
co
u
r
a
g
in
g
team
wo
r
k
,
an
d
o
f
f
er
in
g
g
u
i
d
an
ce
a
n
d
ass
is
tan
ce
to
en
ab
le
h
ea
lth
ca
r
e
p
r
o
f
ess
io
n
als
to
tr
ac
k
an
d
e
n
h
an
ce
th
ei
r
p
er
f
o
r
m
a
n
ce
,
s
u
p
p
o
r
tiv
e
s
u
p
er
v
is
io
n
p
r
o
m
o
tes ex
ce
llen
t
o
u
tco
m
es [
5
0
]
,
[
5
1
]
.
3
.
6
.
Str
eng
t
hs
a
nd
lim
it
a
t
io
ns
I
t
is
th
e
f
ir
s
t
to
co
m
p
ile
th
is
b
o
d
y
o
f
liter
atu
r
e
f
o
r
t
h
e
p
u
r
p
o
s
e
to
co
m
p
r
eh
en
d
th
e
tr
e
n
d
s
in
waste
m
an
ag
em
en
t
i
n
I
n
d
o
n
esian
h
ea
lth
ca
r
e
estab
lis
h
m
en
ts
.
T
h
is
r
ev
iew
co
n
tain
s
a
n
u
m
b
er
o
f
n
o
tewo
r
th
y
lim
itatio
n
s
,
in
clu
d
in
g
th
e
u
s
e
o
f
titl
e
s
ea
r
ch
es
t
o
f
in
d
p
er
tin
en
t
liter
atu
r
e
.
T
h
e
r
ef
o
r
e,
co
n
s
id
er
in
g
th
e
lim
itatio
n
s
o
f
th
e
s
ea
r
ch
,
it
'
s
p
r
o
b
a
b
le
th
at
p
er
tin
en
t
s
tu
d
ies
o
u
g
h
t
to
h
av
e
b
ee
n
in
clu
d
e
d
.
T
o
f
in
d
f
u
r
th
er
p
u
b
licatio
n
s
,
we
d
id
,
h
o
wev
er
,
s
ca
n
th
e
r
ef
er
en
ce
lis
ts
o
f
th
e
in
clu
d
ed
r
esear
ch
.
Seco
n
d
,
a
v
ar
iety
o
f
r
esear
ch
co
n
d
u
cte
d
in
h
o
s
p
ital settin
g
s
wer
e
ex
am
in
ed
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
N
:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
1
4
,
No
.
1
,
Ma
r
ch
20
2
5
:
2
1
9
-
226
224
T
h
er
ef
o
r
e,
th
e
im
p
licatio
n
s
o
f
th
e
s
tu
d
y
'
s
f
in
d
in
g
s
s
h
o
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ld
b
e
r
eg
ar
d
e
d
ca
u
tio
u
s
ly
,
as
it
d
id
n
o
t
clar
if
y
a
co
n
s
is
ten
t
f
ea
tu
r
e
in
o
th
er
ty
p
es
o
f
h
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lth
ca
r
e
in
s
titu
tio
n
s
,
s
u
ch
as
p
r
iv
ate
clin
ics
an
d
p
u
b
lic
h
ea
lth
ce
n
ter
s
.
T
o
r
e
d
u
ce
t
h
is
b
ias,
th
e
au
th
o
r
s
u
t
ilized
p
r
ed
e
f
in
ed
cr
i
ter
ia
to
c
h
o
o
s
e
w
h
ich
a
r
ticles
to
in
clu
d
e
an
d
s
tan
d
ar
d
ized
tem
p
lates f
o
r
d
at
a
ex
tr
ac
tio
n
.
4.
CO
NCLU
SI
O
N
W
e
ca
n
co
n
clu
d
e
th
at
ass
ess
in
g
an
d
m
a
p
p
in
g
th
e
v
ar
io
u
s
d
eter
m
in
a
n
ts
af
f
ec
tin
g
h
o
s
p
i
tal
liq
u
id
m
ed
ical
waste
m
an
ag
em
e
n
t
is
v
er
y
im
p
o
r
tan
t.
R
eg
u
latio
n
is
th
e
m
o
s
t
cr
u
cial
f
ac
to
r
to
r
eg
u
late
all
th
e
p
r
o
ce
s
s
es a
n
d
p
r
o
d
u
cts th
at
af
f
ec
t th
e
en
v
ir
o
n
m
en
t.
C
o
m
p
lia
n
ce
with
r
eg
u
latio
n
s
n
ee
d
s
to
b
ec
o
m
e
a
h
ab
it a
n
d
im
p
r
o
v
e
o
v
er
tim
e.
W
e
s
u
g
g
est s
u
p
p
o
r
tiv
e
s
u
p
er
v
is
io
n
to
d
o
th
at.
RE
F
E
R
E
NC
E
S
[
1]
M
i
n
i
s
t
r
y
o
f
H
e
a
l
t
h
I
n
d
o
n
e
s
i
a
R
e
p
u
b
l
i
c
,
“
R
e
g
u
l
a
t
i
o
n
o
f
m
i
n
i
st
r
y
o
f
h
e
a
l
t
h
r
e
g
a
r
d
i
n
g
c
l
a
ssi
f
i
c
a
t
i
o
n
a
n
d
h
o
sp
i
t
a
l
n
u
m
b
e
r
3
,
”
(
i
n
I
n
d
o
n
e
s
i
a
n
)
,
J
a
k
a
r
t
a
,
I
n
d
o
n
e
si
a
:
M
o
H
,
2
0
2
0
,
p
p
.
1
-
8
0
.
[
2
]
D
.
A
.
A
.
P
u
t
r
i
,
Za
k
i
a
n
i
s,
A
.
A
s
y
a
r
y
,
a
n
d
S
o
f
w
a
n
,
“
A
c
o
m
p
a
r
a
t
i
v
e
a
n
a
l
y
si
s
o
f
h
a
z
a
r
d
o
u
s
me
d
i
c
a
l
w
a
st
e
m
a
n
a
g
e
men
t
c
o
m
p
l
i
a
n
c
e
b
e
f
o
r
e
(
2
0
1
9
)
a
n
d
d
u
r
i
n
g
(
2
0
2
0
)
t
h
e
c
o
v
i
d
-
1
9
p
a
n
d
e
m
i
c
i
n
I
n
d
o
n
e
si
a
,
”
An
n
a
l
i
d
i
I
g
i
e
n
e
Me
d
i
c
i
n
a
Pr
e
v
e
n
t
i
v
a
e
d
i
C
o
m
u
n
i
t
a
,
v
o
l
.
3
5
,
n
o
.
1
,
p
p
.
6
1
–
7
4
,
2
0
2
3
,
d
o
i
:
1
0
.
7
4
1
6
/
a
i
.
2
0
2
2
.
2
5
0
4
.
[
3
]
D
.
M
.
A
ss
e
mu
,
T.
E.
T
a
f
e
r
e
,
Y
.
M
.
G
e
l
a
w
,
a
n
d
G
.
M
.
B
a
n
t
i
e
,
“
H
e
a
l
t
h
c
a
r
e
w
a
st
e
ma
n
a
g
e
m
e
n
t
p
r
a
c
t
i
c
e
a
n
d
a
sso
c
i
a
t
e
d
f
a
c
t
o
r
s
a
mo
n
g
p
r
i
v
a
t
e
a
n
d
p
u
b
l
i
c
h
o
s
p
i
t
a
l
s
o
f
B
a
h
i
r
D
a
r
c
i
t
y
a
d
m
i
n
i
st
r
a
t
i
o
n
,
”
J
o
u
rn
a
l
o
f
En
v
i
r
o
n
m
e
n
t
a
l
a
n
d
P
u
b
l
i
c
H
e
a
l
t
h
,
v
o
l
.
2
0
2
0
,
p
p
.
1
–
1
0
,
O
c
t
.
2
0
2
0
,
d
o
i
:
1
0
.
1
1
5
5
/
2
0
2
0
/
7
8
3
7
5
6
4
.
[
4
]
Y
.
W
e
i
,
M
.
C
u
i
,
Z
.
Y
e
,
a
n
d
Q
.
G
u
o
,
“
En
v
i
r
o
n
me
n
t
a
l
c
h
a
l
l
e
n
g
e
s
f
r
o
m
t
h
e
i
n
c
r
e
a
s
i
n
g
m
e
d
i
c
a
l
w
a
st
e
si
n
c
e
S
A
R
S
o
u
t
b
r
e
a
k
,
”
J
o
u
rn
a
l
o
f
C
l
e
a
n
e
r P
r
o
d
u
c
t
i
o
n
,
v
o
l
.
2
9
1
,
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