Holistic health and environmental risk assessment of PM and bioaerosol emissions in hospital waste and wastewater departments using FMEA and DMRA methods

Bioaerosol and particulate matter (PM) from hospital waste and wastewater pose significant pathogen transmission and workplace safety risks to healthcare workers and surrounding communities, requiring thorough risk assessments. This study pioneers a comprehensive risk assessment of PM and bioaerosol emissions in waste disposal and wastewater treatment departments across four Iranian hospitals, employing cutting-edge methodologies like Failure Mode and Effective Analysis (FMEA) and Decision Matrix Risk Assessment (DMRA) to enhance the precision and efficacy of risk evaluation in these high-stakes environments. The study systematically identified 15 primary risk sources, with Risk Priority Numbers (RPN) ranging from 168 to 900. The investigation involved experts, focusing on evaluating health hazards faced by hospital staff through detailed analysis of emission risks, transmission pathways, and potential health implications of bioaerosols and PM. The research confirmed the reliability of the FMEA checklist for analyzing PM and bioaerosols in waste disposal and wastewater treatment departments, with intra-class correlation coefficients (ICC) and Cronbach's Alpha values of 0.913 and 0.619, respectively. The study revealed that most risks in hospital wards originated from two primary sources: technical device malfunctions and personnel skill deficiencies. Critical high-risk activities were identified, including direct dermal exposure to wastewater and wastes, leachate dispersal during waste transportation, and inadequate segregation of sharp and infectious wastes. The research advocates for comprehensive interventions, including staff training and systematic waste handling, to ensure a safer healthcare environment through One Health strategy integrating technical and educational measures. Thus, DMRA and FMEA are complementary methods that provide an effective risk assessment.