Waste Treatment Innovation For Infusion Bottle Using Soil Solution

Disposal of medical or clinical waste into the environment can cause nosocomial and other environmental pollution. Treatment of medical or clinical waste requires modern technology and very high processing costs. Medical waste treatment requires innovation in processing medical waste to be easy to apply in health care facilities. For this reason, it is necessary to innovate antibacterial methods to clean bacteria. This study used an experimental design using a completely randomized design. The treatment was carried out by rinsing with sterile distilled water seven times, using 45% soil with a contact time of 2 minutes. Experiments in the study were carried out twice. The effect of treatment on decreasing the number of bacteria used a mathematical model of Multiple Linear Regression. The results show that the disinfection of infusion bottles is contaminated with bacteria. When using water only requires rinsing up to 6 times, it is sucient to rinse only once if using a soil solution. Disinfection of infusion bottles contaminated with bacteria using soil solution was able to reduce the number of bacteria by 98%.


Introduction
The hospital as a health service facility, both outpatient and inpatient, is a place where sick people are treated, this can cause disease transmission. The government overcomes this problem with the Minister of Health of the Republic of Indonesia No. 7 of 2019 The regulation regulates hospital environmental health, one of which is environmental health requirements for decontamination through sterilization (Permenkes RI 2019). Disinfection is an effort to reduce or eliminate the number of diseasecausing pathogenic microorganisms (excluding spores) by physical and chemical means. While sterilization is an effort to eliminate all microorganisms by physical and chemical means, one of the requirements for the density of oor and wall germs at the end of the disinfection process is 0 CFU/cm 2 to 5 CFU/cm 2 .
A large number of medical waste that causes complex problems is the high cost of processing clinical waste. Legislation requires medical or clinical waste to be processed not to cause nosocomial and other environmental pollution. Treatment of medical or clinical waste requires more sophisticated technology and very high processing costs. Medical waste treatment requires innovation in processing medical waste so that it is easy to apply in health care facilities(Irfa'i et al. 2020).
Previous research by Marsum, et.al to reduce the number of pathogenic bacteria Bacillus cereus contained in syringe solid waste by using several techniques, including autoclave sterilization with a temperature of 121 0 C for 15 minutes, andesol soil 45% or with a combination of the two methods to increase potency sterilization of medical waste is proven to be effective (Marsum et al. 2020).
The antimicrobial activity of clay nanocomposites tested against bacterial strains of S. aureus, Enterobacter faecalis, Pseudomonas aeruginosa, and E. coli found that the antibacterial activity depends on pH and the clay matrix. In the teachings of Islam, to clean unclean dirt, including bacteria on the body, it is washed seven times, one of which is mixed with soil. The preliminary test to clean the infusion bottle contaminated with bacteria with dry soil still leaves some bacteria, while cleaning the bacteria with water alone must be done repeatedly. For this reason, in this study, mixing water with soil was carried out to increase the effectiveness of cleaning bacteria in infusion bottles.

Method
This study used experimental design using a completely randomized design by taking samples from Tugurejo Hospital Semarang. It is conditioned in a particular storage room to stabilize the number of bacteria in the infusion bottle. The treatment was focused on the effectiveness of rinsing water and soil to determine the decrease in the number of pre and post-bacteria in-hospital infusion bottle waste. The treatment was carried out by rinsing with sterile Aquades 7 times, one of which was using 45% soil with a contact time of 2 minutes. The number of repetitions in the treatment of this study was calculated using the Federer formula approach, with the result of 2 repetitions. Implementation of the treatment by swabs To prove that in this study the number of bacteria in all treatment groups in homogeneous or comparable conditions, the One Way Anova test was carried out, the results of which are listed in Table 1. The results of this study indicate that the infusion bottle is contaminated with bacteria when it is only washed with water with a frequency of many times, as shown in Table 2.  Table 2 shows that to clean hospotal infusion bottles from bacterial contamination, using water requires rinsing up to 6 times, while rinsing with water and soil only requires rinsing once.
Health care waste consists of waste generated by health facilities, medical laboratories, and biomedical research facilities. Improper treatment of this waste poses a severe risk of disease transmission to waste workers, health workers, patients, and the general public through exposure to infectious agents. Poor waste management produces hazardous and infectious contaminants to the community. Contamination of highly infectious agents such as the COVID-19 virus has created enormous instability in the handling of healthcare and recycling waste due to the volume of waste generated and its contagious nature.
Proper management of healthcare waste can add value by reducing the spread of the COVID-19 virus and increasing the recycling of materials rather than sending them to land lls. Disinfection and segregation of health care waste facilitates sustainable management and enables its use for valuable purposes. given, which can be seen in Figure 1. Figure 1 shows that initially, all treatment groups had the same number of bacteria, which was 21.4; After being given various treatments, the position of groundwater rinsed, in any position when rinsed with groundwater was able to clean the bacterial contamination of the infusion bottle waste. The decrease in the number of bacteria effects from the treatment after being analyzed using a linear regression mathematical model which was controlled through analysis by the number of pre bacteria resulted in a number of differences in the number of bacteria for each treatment compared to the control group as shown by the regression coe cient (B), in Table 3.  Table 3. of the seven positions of rinsing groundwater, starting from groundwater to rinse infusion bottles contaminated with bacteria, the rst rinse directly with groundwater to rinse groundwater at the seventh rinse position, can reduce the number of different bacteria and is increasingly in the backward position. the ability to reduce the number of bacteria decreases. However, in any position treatment when rinsed with ground water was able to clean the bacteria that contaminate the infusion bottle. As stated in the table, the infusion bottle contaminated with bacteria when directly washed with groundwater was able to reduce the number of bacteria by 19.9 CFU lower than the control group, and the decrease was statistically signi cant (p<0.001). The rst rinse with ground water was able to clean up 98% of bacteria. In subsequent rinses from the second to seventh treatments, the reduction of bacteria appeared to be less effective than if the water and soil treatments were carried out in the rst rinse. However, the treatment in the rst to seventh rinses was still proven to reduce the number of bacteria.
This difference in effectiveness may be due to differences in the ability and viability of different bacteria found on the plabot. So there is a possibility that bacteria that still survive in the nal rinse are more resistant to the antibacterial power of the soil. Other studies have suggested that soil and mineral content in modi ed soils can be used to remove pathogenic bacteria. The mechanisms that occur in this process are mainly cation exchange and ion-dipole coordination interactions and hydrogen bonds; and this process largely depends on the isoelectric point, the size of the molecule, the shape of the molecule, and the pH of the solution. removed from its natural environment and activated with deionized water for medical applications, soil rebalances with new uids. During this process, dissolved and oxidized minerals such as pyrite, plagioclase, smectite release metals that suppress the growth of pathogenic bacteria.
In Islamic jurisprudence, puri cation according to Islam (thaharah) the process of removing najis requires the process of rinsing using several washes of water where one of the washes is mixed with soil. Mixing soil with water will produce a mixture of solutions, colloids, and suspensions of clay and humus. Humus particles dissolved in water will produce a solution that can function as a surfactant. The combination of clay nanoparticles and surfactants has been known to have antiviral properties. (Liang et al. 2014) So it can be understood that the presence of water and soil produces a system that contains antiviral powers. While the antibacterial properties are also owned by the clay from the dissolved aluminum(Morrison, Misra, and Williams 2016).
To see the difference in the effects of the seven types of treatment after being tested using the Least Signi cant Different (LSD), which is indicated by the difference in mean between groups, as shown in Table 4.  Table 4 illustrates that rinsing the infusion bottle contaminated with bacteria directly with groundwater is better than rinsing in the second position and so on (p=0.035). The difference in the decrease in the number of bacteria was 11.2 compared to the control group.
The hospital as a health service place that serves inpatient and outpatient services in service activities produces medical waste. which is a group of hazardous and toxic waste in health service activities. Furthermore. the packaged waste is submitted to CV. Timdis to be handed over to a plastic processor. namely Fila Djaya Plasindo. then the hospital will get income in the form of plastic baggies of yellow and black garbage containers according to the hospital's request (Madjeed 2020; Setyawati 2020).
The technology for removing hazardous waste is incineration. The incineration system can reduce the volume of medical waste by up to 99.95%. In addition. incineration technology can digest medical waste materials that are harmful to the environment and destroy pathogenic bacteria. However. the incineration system has its drawbacks. One disadvantage is that it produces residual ash and waste that still contains heavy metals. Therefore. improvement in incineration management is needed. One of the efforts that can be done is the treatment of residues and ash waste. (Sutrisno and Meilasari 2020) According to Marsum et al (2020). waste treatment before being used can use several techniques including autoclave sterilization with a temperature of 121°C for 15 minutes. 45% andesol soil with a contact time of 2 minutes or a combination of the two methods to increase the sterilization power of medical waste (Marsum et al. 2020).
Clay (andosol) which is very abundant can be used as an anti-bacterial by applying tubular SiO2-NT @ Cu nanocomposites that can inhibit the growth of E. coli and S. aureus effectively with minimal inhibitory concentrations (MIC) of 2.0 mg/mL and 0.6mg/mL (Dong et al. 2020).
The antimicrobial activity of clay nanocomposites tested against bacterial strains of S. Aureus. E. Faecalis. P. Aeruginosa. and E. Coli. was then evaluated by nding the minimum inhibitory concentration. It was found that the antibacterial activity depends on the pH and also on the clay matrix (Holešová et al. 2021). The role of divalent and trivalent positive cations. including iron and aluminum in the inhibition of bacteria with low pH (Behroozian et al. 2020).

Conclusion
Disinfection of infusion bottles using a mixture of water and soil is more effective than using water without a mixture of soil. The effectiveness of the disinfection of a mixture of water and soil reaches 98% in the rst month.

Declarations
Ethical Approval. Not applicable Consent to Participate. Not applicable Consent for publication. Not applicable Data availability. All data generated or analysed during this study are included in this published article.
Funding. The research used budget funds the Poltekkes Kemenkes Semarang Competing Interests. The authors declare that there is no con ict of interest regarding the publication of this manuscript. Figure 1 Changes in the decrease in the number of bacteria between the treatment group and the control group