Mohammad Azmal - Academia.edu (original) (raw)
Papers by Mohammad Azmal
Patient Safety in Surgery, Jul 26, 2023
Background Adverse events have become a global problem and are an important indicator of patient ... more Background Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran. Methods The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables. Results The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events. Conclusion This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.
International Journal for Quality in Health Care, 2010
Objective. The objective of this study was to investigate the association between 11 patient safe... more Objective. The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defences. Design. Data were gathered within a cross-sectional, retrospective survey. Setting. Emergency departments (EDs) in the Netherlands. Participants. Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. Main Outcome Measures. Implementation of the separate organizational patient safety defences (0 ¼ insufficient/sufficient, 1 ¼ good). Results. Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defences. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defences, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences. Conclusions. Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.
Journal of Payavard Salamat, 2016
Iranian South Medical Journal, 2020
Background: Low back pain (LBP) is currently the most common musculoskeletal disorder and a major... more Background: Low back pain (LBP) is currently the most common musculoskeletal disorder and a major cause of disability. A remarkable percentage of diagnostic imaging prescriptions are not necessary, therefore, this study aimed to determine the necessity of lumbar MRI prescriptions in Bushehr teaching hospitals in 2018. Materials and Methods: This cross-sectional descriptive-analytical study recruited a sample size of 273 individuals from a population of all patients presenting to Bushehr teaching hospitals for low back pain and undergoing lumbar MRI. Data were collected using a questionnaire with demographic questions and prescription-related questions. SPSS 24 software was used for data analysis. Results: Of the 273 patients studied, 54% were female and 46% male. The mean age of patients was 43 years and 72% of all patients were between 21 and 50 years old. MRI was deemed unnecessary for approximately 44% of patients. Furthermore, MRI results were reported absolutely normal in 30% o...
iAbstract Background: The existence of an organization depends on communications and this is an a... more iAbstract Background: The existence of an organization depends on communications and this is an area that managers spend most of their time on. Recognition of communication skills accompanied with its implementation is among the essential parameters of successful management in any organization. Objective: To determine the correlation between emotional intelligence and communicational skills among managers of educational hospitals in Qazvin. Methods: This was a cross-sectional study performed on 78 managers of educational hospitals in Qazvin in 2008. Data were gathered by completing the Shearing’s Emotional Intelligence Questionnaire (EIQ), Berton’s Communicational Skills Questionnaire, and the demographic characteristics questionnaire using Likert’s scale for scoring the questions. Data were analyzed using descriptive statistical indexes, Pearson’s correlation coefficient, independent t-test and one way ANOVA. Findings: Our findings showed that there was a significant positive corre...
Objective: Outsourcing as an effective strategy in public management has brought the attention of... more Objective: Outsourcing as an effective strategy in public management has brought the attention of policy makers for long time ago. This strategy as a public -private partnership arrangement (PPP) was coined to increase efficiency and quality in public organizations .in this study we aimed to investigate the frequency of using common outsourcing models in Bushehr University of Medical Sciences (BUMS).Methods: This is a descriptive and cross-sectional study conducted in year 2020 in BUMS. Research population was all the deputies, hospitals and health networks affiliated to BUMS. This study was carried out in four stages including: literature review, construction of a checklist, quality assurance of gathered data and finally categorization of the outsourced services. Result: Results showed that there was a total of 7 various outsourcing models on which 189 cases of services have been outsourced. 108 cases out of 189 were clinical and the rest non-clinical. Among the outsourcing models,...
BMJ Open, 2017
Background and aims: In medical organizations, nurses utilize evidence-based practice (EBP) in or... more Background and aims: In medical organizations, nurses utilize evidence-based practice (EBP) in order to evaluate their skills, develop and implement policies and procedures, carry out effective clinical interventions, and prepare care plans to enhance positive outcomes for patients. The aim of this study was to investigate the nurses' understanding of EBP and its relevant barriers in the selected hospitals in Iran. Methods: The present study was a descriptive- analytical research that was conducted using a cross-sectional design in order to investigate the nurses' understanding of EBP and its barriers. In so doing, 260 nurses were randomly selected from 6 teaching hospitals in Qazvin, Iran. Upton Evidence-based Practice Questionnaire and Funk et al. Barriers Scale were employed to measure EBP dimensions and the relevant barriers, respectively. For analyze of collected data, frequency distribution tables, ANOVA, and linear regression coefficient were used. Results: According ...
Medical Journal of the Islamic Republic of Iran, 2014
Background: Evidence-based practice (EBP) provides nurses a method to use critically appraised an... more Background: Evidence-based practice (EBP) provides nurses a method to use critically appraised and scientifically proven evidence for delivering quality health care and the best decision that leads to quality outcomes. The purpose of this study was to measure the practice, attitude and knowledge/skill of evidence-based practice of nurses in a teaching hospital in Iran. Methods: This cross-sectional study was conducted in 2011.The study sample was composed of 195 nurses who were working at the Fatemeh Zahra Hospital affiliated to Bushehr University of Medical Sciences (BPUMS). The survey instrument was a questionnaire based on Upton and Upton study. This tool measures Nurses' perceptions in the three sub-scales of practice, attitude and knowledge/skill of evidence-based practice. Descriptive statistical analysis was used to analyze the data. Pearson correlation coefficients were used to examine the relationship between subscales. Results: The overall mean score of the evidence-ba...
Journal of Hospital, 2013
Medical Journal of the Islamic Republic of Iran, 2015
Background: Patient education is widely recognized as a core component of nursing. Patient educat... more Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to ...
The genus Pyramimonas Schmarda is a group of scaly green flagellates. The taxonomy and phylogeny ... more The genus Pyramimonas Schmarda is a group of scaly green flagellates. The taxonomy and phylogeny of the genus Pyramimonas were investigated in the present study by analysing morphological and molecular data. Phylogenetic studies using both the morphological and molecular characteristics are very important to know its placement among all organisms. From the morphological and molecular data (SSU rDNA and rbcL genes) it is understood that Pyramimonadales showed early divergences of the Chlorophyta, hence Pyramimonas, as a member of the Pyramimonadales, is considered a key organism in the evolution of Chlorophyta or even green plants. The Ryukyu Archipelago is a chain of islands located to the south west of Japan in the western Pacific Ocean. The islands lie in the direct path of the Kuroshio Current, a body of warm equatorial water that sustains rich and diverse coral reefs, mangrove swamps and many diverse marine organisms. The Ryukyu Islands are, therefore, hotspots for their diversi...
Background: Conflict and dispute are inevitable phenomena in man’s life and considered as necessi... more Background: Conflict and dispute are inevitable phenomena in man’s life and considered as necessity of social activities. Healthcare system, especially nursing ward is susceptible to develop kinds of conflict that must be directed and controlled by head nurses. Negotiation as an advantageous, effective and factual method is known to resolve the conflict. Objective: This research intended to investigate the correlation between nurses’ conflict level and head nurses negotiation styles at general hospitals in province of Boushehr. Methods: This was a kind of correlation study carried out in a given time course in 2007. The study population consisted of 362 nurses and 53 head nurses from general hospitals in Boushehr province south of Iran. Two questionnaires including the Dubrin conflict and Pierre negotiation styles questionnaires were used to collect data based on literature survey. Descriptive and analytic statistics were used for data analysis. Findings: Results showed that the nur...
Journal of Biology and Today's World
Journal of Biology and Today's World, 2016
It is necessary to achieve clinical effectiveness through evidence-based practice in modern healt... more It is necessary to achieve clinical effectiveness through evidence-based practice in modern healthcare organization all over the world. Evidence-based practice is critical to improve the quality of health care. The purpose of this study was to identify the knowledge, attitude and evidence-based performance and barriers of its usage among nurses. This is an applied, descriptive and cross-sectional survey that was carried out in selected hospitals under supervision of Iran University of Medical Sciences in 2015. Statistical society consisted of 250 nurses working in different departments of hospitals who were selected randomly. Data was collected through the following standard questionnaires: Evidence-Based Practice Questionnaire (EBPQ) and assessing the barriers of research usage. Finally, data analysis was done using SPSS and Pearson Test. In this study, the levels of knowledge, attitude and evidence-based practice of nurses were measured as 60.42, 85.66 and 57.66 respectively. In addition, there was significant relation between knowledge, attitude and practice. The main barriers to use of research in performance were non-participation of physicians, lack of permission by manager, time deficiency and inadequacy of the new publication rate. Earning research and IT skills improves knowledge of nurses. Through increasing awareness of nurses about positive effects of evidence-based practice in patients care, nurses will pay more attention to evidences. Enhancing the knowledge has improved attitude and this improvement has led to increase level of performance. © 2016 Zahra Naderkhah et al.
Journal of Biology and Today's World, 2016
Due to an increase in population and the number of health-care centers and increasing use of disp... more Due to an increase in population and the number of health-care centers and increasing use of disposable medical products over the last decades, there has been a remarkable increase in health-care wastes which can cause numerous problems if they are not managed properly. The present study was carried out in order to select the best method to manage health-care wastes through multi-criteria decision making (MCDM) approaches. The present study was a descriptive-applied research that was conducted in Qazvin in 2016. The study sample consisted of 28 experts belonging to 5 groups that were selected through purposefully sampling method. After the questionnaire was designed, Analytic Hierarchy Process (AHP) was employed to measure the weight of the criteria. Afterward, TOPSIS method was utilized to rank different disposal methods of health-care waste. Based on the opinion of experts of the 5 groups about the weight of the criteria and the results of the weighting phase, it was indicated that the highest weight was related to air residuals criterion and environmental impacts, and the lowest to the cost criterion. According to the study inclusion criteria, the final results of the ranking are respectively irradiation (0.83), microwave (0.79), steam sterilization (autoclave) (0.75), chemical disinfection (0.55), sanitary landfill (0.35), and finally incineration (0.29). The results of the current study indicated that according to the groups under investigation, the best methods to dispose of health-care wastes in Qazvin are irradiation and microwave. According to this finding, the policymakers can plan to make more use of these two methods in order to dispose and disinfect health-care wastes.
Patient Safety in Surgery, Jul 26, 2023
Background Adverse events have become a global problem and are an important indicator of patient ... more Background Adverse events have become a global problem and are an important indicator of patient safety. Patient safety culture is essential in efforts to reduce adverse events in the hospital. This study aimed to investigate the status of the patient safety culture, the frequency of adverse events, and the relationship between them in Qazvin's hospitals in Iran. Methods The present study is a descriptive-analytical study conducted in six hospitals in Qazvin, Iran, in 2020. The study population was nurses working in Qazvin hospitals. We collected data via a patient safety culture questionnaire and an adverse event checklist. Three hundred sixty nurses completed questionnaires. Multiple logistic regression was used to investigate the relationship between variables. Results The highest mean of patient safety culture was related to the organizational learning dimension (3.5, SD = .074) and feedback and communication about errors (3.4, SD = 0.82). The participants gave the lowest score to dimensions of exchanges and transfer of information (2.45,=0.86) and management support for patient safety (2.62,Sd = 0.65). Management's support for patient safety, general understanding of patient safety culture, teamwork within organizational units, communication and feedback on errors, staff issues, and information exchange and transfer were significant predictors of adverse events. Conclusion This study confirms patient safety culture as a predictor of adverse events. Healthcare managers should provide the basis for improving the patient safety culture and reducing adverse events through methods such as encouraging the reporting of adverse events and also holding training courses for nurses.
International Journal for Quality in Health Care, 2010
Objective. The objective of this study was to investigate the association between 11 patient safe... more Objective. The objective of this study was to investigate the association between 11 patient safety culture dimensions and the implementation of 7 organizational patient safety defences. Design. Data were gathered within a cross-sectional, retrospective survey. Setting. Emergency departments (EDs) in the Netherlands. Participants. Thirty-three EDs of non-academic hospitals, which belong to the clientele of Dutch largest medical liability insurer. Main Outcome Measures. Implementation of the separate organizational patient safety defences (0 ¼ insufficient/sufficient, 1 ¼ good). Results. Analyses showed that several culture dimensions were negatively or positively associated with the implementation of the patient safety defences. A culture in which hospital handoffs and transitions were perceived adequate was related to less frequent implementation of four of seven organizational patient safety defences, whereas a culture with well-perceived hospital management support for patient safety predicted more frequent implementation of four of seven organizational patient safety defences. Conclusions. Results suggest that well-perceived culture dimensions might inhibit improvements by lack of a sense of urgency as well as facilitate improvements by inducing feelings of support for organizational changes and improvements. The influence of patient safety culture appeared to be not always as straightforward as it seems to be in advance.
Journal of Payavard Salamat, 2016
Iranian South Medical Journal, 2020
Background: Low back pain (LBP) is currently the most common musculoskeletal disorder and a major... more Background: Low back pain (LBP) is currently the most common musculoskeletal disorder and a major cause of disability. A remarkable percentage of diagnostic imaging prescriptions are not necessary, therefore, this study aimed to determine the necessity of lumbar MRI prescriptions in Bushehr teaching hospitals in 2018. Materials and Methods: This cross-sectional descriptive-analytical study recruited a sample size of 273 individuals from a population of all patients presenting to Bushehr teaching hospitals for low back pain and undergoing lumbar MRI. Data were collected using a questionnaire with demographic questions and prescription-related questions. SPSS 24 software was used for data analysis. Results: Of the 273 patients studied, 54% were female and 46% male. The mean age of patients was 43 years and 72% of all patients were between 21 and 50 years old. MRI was deemed unnecessary for approximately 44% of patients. Furthermore, MRI results were reported absolutely normal in 30% o...
iAbstract Background: The existence of an organization depends on communications and this is an a... more iAbstract Background: The existence of an organization depends on communications and this is an area that managers spend most of their time on. Recognition of communication skills accompanied with its implementation is among the essential parameters of successful management in any organization. Objective: To determine the correlation between emotional intelligence and communicational skills among managers of educational hospitals in Qazvin. Methods: This was a cross-sectional study performed on 78 managers of educational hospitals in Qazvin in 2008. Data were gathered by completing the Shearing’s Emotional Intelligence Questionnaire (EIQ), Berton’s Communicational Skills Questionnaire, and the demographic characteristics questionnaire using Likert’s scale for scoring the questions. Data were analyzed using descriptive statistical indexes, Pearson’s correlation coefficient, independent t-test and one way ANOVA. Findings: Our findings showed that there was a significant positive corre...
Objective: Outsourcing as an effective strategy in public management has brought the attention of... more Objective: Outsourcing as an effective strategy in public management has brought the attention of policy makers for long time ago. This strategy as a public -private partnership arrangement (PPP) was coined to increase efficiency and quality in public organizations .in this study we aimed to investigate the frequency of using common outsourcing models in Bushehr University of Medical Sciences (BUMS).Methods: This is a descriptive and cross-sectional study conducted in year 2020 in BUMS. Research population was all the deputies, hospitals and health networks affiliated to BUMS. This study was carried out in four stages including: literature review, construction of a checklist, quality assurance of gathered data and finally categorization of the outsourced services. Result: Results showed that there was a total of 7 various outsourcing models on which 189 cases of services have been outsourced. 108 cases out of 189 were clinical and the rest non-clinical. Among the outsourcing models,...
BMJ Open, 2017
Background and aims: In medical organizations, nurses utilize evidence-based practice (EBP) in or... more Background and aims: In medical organizations, nurses utilize evidence-based practice (EBP) in order to evaluate their skills, develop and implement policies and procedures, carry out effective clinical interventions, and prepare care plans to enhance positive outcomes for patients. The aim of this study was to investigate the nurses' understanding of EBP and its relevant barriers in the selected hospitals in Iran. Methods: The present study was a descriptive- analytical research that was conducted using a cross-sectional design in order to investigate the nurses' understanding of EBP and its barriers. In so doing, 260 nurses were randomly selected from 6 teaching hospitals in Qazvin, Iran. Upton Evidence-based Practice Questionnaire and Funk et al. Barriers Scale were employed to measure EBP dimensions and the relevant barriers, respectively. For analyze of collected data, frequency distribution tables, ANOVA, and linear regression coefficient were used. Results: According ...
Medical Journal of the Islamic Republic of Iran, 2014
Background: Evidence-based practice (EBP) provides nurses a method to use critically appraised an... more Background: Evidence-based practice (EBP) provides nurses a method to use critically appraised and scientifically proven evidence for delivering quality health care and the best decision that leads to quality outcomes. The purpose of this study was to measure the practice, attitude and knowledge/skill of evidence-based practice of nurses in a teaching hospital in Iran. Methods: This cross-sectional study was conducted in 2011.The study sample was composed of 195 nurses who were working at the Fatemeh Zahra Hospital affiliated to Bushehr University of Medical Sciences (BPUMS). The survey instrument was a questionnaire based on Upton and Upton study. This tool measures Nurses' perceptions in the three sub-scales of practice, attitude and knowledge/skill of evidence-based practice. Descriptive statistical analysis was used to analyze the data. Pearson correlation coefficients were used to examine the relationship between subscales. Results: The overall mean score of the evidence-ba...
Journal of Hospital, 2013
Medical Journal of the Islamic Republic of Iran, 2015
Background: Patient education is widely recognized as a core component of nursing. Patient educat... more Background: Patient education is widely recognized as a core component of nursing. Patient education can lead to quality outcomes including adherence, quality of life, patients' knowledge of their illness and self-management. This study aimed to clarify patient education process in teaching hospitals affiliated to Tehran University of Medical Sciences (TUMS) in Iran. Methods: This cross-sectional study was conducted in 2013. In this descriptive quantitative study, the sample covered 187 head nurses selected from ten teaching hospitals through convenience sampling. Data were collected with a questionnaire developed specifically for this study. The questionnaire measured patient education process in four dimensions: need assessment, planning, implementing and evaluating. Results: The overall mean score of patient education was 3.326±0.0524. Among the four dimensions of the patient education process, planning was in the highest level (3.570±0.0591) and the lowest score belonged to ...
The genus Pyramimonas Schmarda is a group of scaly green flagellates. The taxonomy and phylogeny ... more The genus Pyramimonas Schmarda is a group of scaly green flagellates. The taxonomy and phylogeny of the genus Pyramimonas were investigated in the present study by analysing morphological and molecular data. Phylogenetic studies using both the morphological and molecular characteristics are very important to know its placement among all organisms. From the morphological and molecular data (SSU rDNA and rbcL genes) it is understood that Pyramimonadales showed early divergences of the Chlorophyta, hence Pyramimonas, as a member of the Pyramimonadales, is considered a key organism in the evolution of Chlorophyta or even green plants. The Ryukyu Archipelago is a chain of islands located to the south west of Japan in the western Pacific Ocean. The islands lie in the direct path of the Kuroshio Current, a body of warm equatorial water that sustains rich and diverse coral reefs, mangrove swamps and many diverse marine organisms. The Ryukyu Islands are, therefore, hotspots for their diversi...
Background: Conflict and dispute are inevitable phenomena in man’s life and considered as necessi... more Background: Conflict and dispute are inevitable phenomena in man’s life and considered as necessity of social activities. Healthcare system, especially nursing ward is susceptible to develop kinds of conflict that must be directed and controlled by head nurses. Negotiation as an advantageous, effective and factual method is known to resolve the conflict. Objective: This research intended to investigate the correlation between nurses’ conflict level and head nurses negotiation styles at general hospitals in province of Boushehr. Methods: This was a kind of correlation study carried out in a given time course in 2007. The study population consisted of 362 nurses and 53 head nurses from general hospitals in Boushehr province south of Iran. Two questionnaires including the Dubrin conflict and Pierre negotiation styles questionnaires were used to collect data based on literature survey. Descriptive and analytic statistics were used for data analysis. Findings: Results showed that the nur...
Journal of Biology and Today's World
Journal of Biology and Today's World, 2016
It is necessary to achieve clinical effectiveness through evidence-based practice in modern healt... more It is necessary to achieve clinical effectiveness through evidence-based practice in modern healthcare organization all over the world. Evidence-based practice is critical to improve the quality of health care. The purpose of this study was to identify the knowledge, attitude and evidence-based performance and barriers of its usage among nurses. This is an applied, descriptive and cross-sectional survey that was carried out in selected hospitals under supervision of Iran University of Medical Sciences in 2015. Statistical society consisted of 250 nurses working in different departments of hospitals who were selected randomly. Data was collected through the following standard questionnaires: Evidence-Based Practice Questionnaire (EBPQ) and assessing the barriers of research usage. Finally, data analysis was done using SPSS and Pearson Test. In this study, the levels of knowledge, attitude and evidence-based practice of nurses were measured as 60.42, 85.66 and 57.66 respectively. In addition, there was significant relation between knowledge, attitude and practice. The main barriers to use of research in performance were non-participation of physicians, lack of permission by manager, time deficiency and inadequacy of the new publication rate. Earning research and IT skills improves knowledge of nurses. Through increasing awareness of nurses about positive effects of evidence-based practice in patients care, nurses will pay more attention to evidences. Enhancing the knowledge has improved attitude and this improvement has led to increase level of performance. © 2016 Zahra Naderkhah et al.
Journal of Biology and Today's World, 2016
Due to an increase in population and the number of health-care centers and increasing use of disp... more Due to an increase in population and the number of health-care centers and increasing use of disposable medical products over the last decades, there has been a remarkable increase in health-care wastes which can cause numerous problems if they are not managed properly. The present study was carried out in order to select the best method to manage health-care wastes through multi-criteria decision making (MCDM) approaches. The present study was a descriptive-applied research that was conducted in Qazvin in 2016. The study sample consisted of 28 experts belonging to 5 groups that were selected through purposefully sampling method. After the questionnaire was designed, Analytic Hierarchy Process (AHP) was employed to measure the weight of the criteria. Afterward, TOPSIS method was utilized to rank different disposal methods of health-care waste. Based on the opinion of experts of the 5 groups about the weight of the criteria and the results of the weighting phase, it was indicated that the highest weight was related to air residuals criterion and environmental impacts, and the lowest to the cost criterion. According to the study inclusion criteria, the final results of the ranking are respectively irradiation (0.83), microwave (0.79), steam sterilization (autoclave) (0.75), chemical disinfection (0.55), sanitary landfill (0.35), and finally incineration (0.29). The results of the current study indicated that according to the groups under investigation, the best methods to dispose of health-care wastes in Qazvin are irradiation and microwave. According to this finding, the policymakers can plan to make more use of these two methods in order to dispose and disinfect health-care wastes.