Sustainable medical waste management in Bangladesh

The scenario of medical waste management in different hospitals is not satisfactory as pollution of the environment with toxic substances is contributing to public health problem

To ensure environmental security and toxicants free nature, sustainable medical waste management is indispensable. The study was conducted in some selected Health Care Establishments (HCEs) of Ishwarganj Upazila under Mymensingh District. For the evaluation of medical waste management capacities, 1 government hospital and 7 private diagnostic centers of Ishwarganj Upazila were selected. Data were collected from total 78 respondents, among them 34 patients, 8 administrative officers, 2 doctors, 15 technicians, 12 cleaners and 7 nurses to inspect the presented medical waste management, level of awareness and training of the individuals involved in the hospital premises. In Addition, data were collected from each Health Care Establishments (HCEs) to quantify waste generation rate that found to be 1.08 kg-1bed-1day-1 and 0.31 kg -1patient -1day-1. The percentage of reusable waste, sharp waste, infectious waste, general waste and chemical and radioactive waste generation were 11.3 per cent, 10.75 per cent, 9.13 per cent, 67.5 per cent and 1.5 per cent, in that order. In this study, respondents provide their outlook in relation to nearby discarding places of waste in open dumping at Kachamatia river site (very inimical for river ecology), pits, municipal dustbin and others respectively 50.68 per cent, 30.14 per cent, 10.16 per cent and 8.22 per cent of total respondent. About 30.5 per cent respondents stated as adequate of existing hospital waste management, rest 69.5 per cent stated as inadequate. In the statistics of getting training, 35 per cent staffs got training and 65 per cent staffs did not get training on sustainable medical waste management strategies. In relation with the training methods 64.5 per cent respondents showed their interest in video and lecture method, 19 per cent for video, 11.5 per cent for lecture and 6 per cent for other methods. This paper explains the importance of sustainable treatment of medical waste for nature-ecology nexus. Finally some recommendations are provided for superior management of medical wastes.

The scenario of medical waste management in different types and category of hospitals are not satisfactory where polluting the environment with toxic substances contributing to public health problem. Bangladesh has so many public hospitals, medical college hospitals, district hospitals and upazila health complexes. Moreover, a good number of private hospitals and clinics are also providing health care services. In the majority public and private hospitals there are no systemic approaches to medical waste disposal.

The Ministry of Health and Family Welfare (MOH and FW) already started to address the medical waste management as one of the priority program by including it as one of the critical area among the identified six critical areas under health, nutrition and population sector program. In Bangladesh, the rapid increase of hospitals, clinics, diagnostic laboratories etc. in Mymensingh district exerts a tremendous impact on human health ecology. About 5  per cent of the total population in Bangladesh is thought to suffer from chronic hepatitis B infection. Most of the clinical wastes (e.g. syringes, needles, saline drips, discarded food, gauze, vials, and ampoules) are collected by women and children who re-sell those despite of the deadly health risks. However, the fundamental objectives: To investigate the existing management status of hospital wastes in the study area; To observe the level of knowledge and awareness of individuals involved in the hospital premises; To suggest remedial measures for better management of medical wastes in the study area.

The study was conducted in some of the Health Care Establishment (HCEs) belonging to the Ishwargonj upazila under Mymensingh district. They are Ishwarganj Upazilla Health Complex (IUHC), Emdo Diagnostic Centre (EDC), New Incaf Diagnostic Centre (NIDC), Buda Diagnostic Centre (BDC), Modern Diagnostic Centre (MDC), New Lab Diagnostic Centre (NLDC), Apon Diagnostic Centre (ADC), and Sheba Diagnostic Centre (SDC). One Government hospital and seven private diagnostic centers were selected as the sample points.

Primarily, it includes Medical waste categorization – clinical waste, laboratory waste, Non-clinical waste and kitchen waste. A large storage size is required for a communal container, while an individual storage is sized to accommodate the waste generated by a family for normally two or three days. The ultimate disposal of waste including those wastes collected and transported directly the residual substance from various waste processing plants that are of no further use. The options available for disposal are – Open dumping, sanitary land filling and Incineration. The respondents provided information from their practical experience. In order to minimize the response error questions were asked in simple Bengali language. After completion of each interview, it was checked to be sure that information had been properly recorded.

Blood bags, saline bags, syringe, bottle of medicine, plastics materials etc were categorized as reusable medical waste. Among the HCEs, Ishwarganj Upazilla Health Complex (IUHC) generated the lowest 7 per cent of reusable waste, Emdo Diagnostic Centre (EDC) generated second highest (13 per cent) percent of reusable waste, New Lab Diagnostic Centre (NLDC), Buda Diagnostic Centre (BDC) generated 10 per cent reusable waste, Modern Diagnostic centre (MDC) generated 11 per cent reusable waste, New Incaf Diagnostic centre (NLDC) generated 12 per cent reusable waste, Apon Diagnostic Centre (ADC) generated 12 per cent reusable waste, and Sheba Diagnostic centre (SDC) generated highest 14 per cent of reusable waste.

In the studied HCEs total 73 respondents provide their opinion about existing disposal place of waste in collection system. Among them 37 respondents preferred dispose their waste in open dumping at Kachamatia river site; they were 50.68 per cent of total respondents.22 respondents preferred dispose their waste in pits and they were 30.14 per cent of total respondents.8 respondents preferred dispose their waste in municipal dustbin and they were 10.16 per cent of total respondents, rest 6 respondents preferred dispose their waste in others, they were 8.22 per cent of total respondents.

In the studied HCEs total 73 respondents provide their opinion about time of waste collection from secondary source to final disposal place. Among them 42 respondents preferred morning about time of waste collection from secondary source to final disposal place; they were 57 per cent of total respondents.18 respondents preferred noon and they were 25 per cent of total respondents. Rest 13 respondents preferred random time and they were 18 per cent of total respondents.

The field survey shows different levels of awareness from different respondents. In the measurement of getting training of the studied HCEs, 35 per cent staffs got training about the hospital waste management and 65 per cent staffs did not get training of the total respondents.

The research focuses generation and the existing management system of medical wastes in hospitals and diagnostic centers in Ishwarganj upazila. The level of awareness on medical waste is medium but they are not able to manage the waste systematically since there are lacking of systems, rules and regulations, and financial support. Recommendations are given below: Raise awareness and education on medical waste issues, segregation of medical waste should be done at the point of generation.

Different colored bags should be used for collection of hazardous and non-hazardous waste, modem techniques and technological devices such as moving dustbins, crane, separate collection system bins etc should be used in hospital waste management system, To avoid the risk of health effect from the wastes  on-site incineration of the   entire hospital waste with appropriate air pollution controls, is the best available  means of processing prior to disposal, Re-use, recycle and reduce of waste generation should be followed through composting and following other process, To minimize the generation of medical waste, good housekeeping, replacement of chemicals, etc. may be adopted, Training programme on safe handling of medical waste can be organized for medical staff, Government should promulgate and implement laws and regulations regarding medical waste management, A strong monitoring system should be developed to monitor the whole management system.

Shishir Reza is Environmental Analyst, Bangladesh Economic Association

Sharmin Akter, Urban Planner, Bangladesh Institute of Planners

 

Sustainable medical waste management in Bangladesh

The scenario of medical waste management in different hospitals is not satisfactory as pollution of the environment with toxic substances is contributing to public health problem

To ensure environmental security and toxicants free nature, sustainable medical waste management is indispensable. The study was conducted in some selected Health Care Establishments (HCEs) of Ishwarganj Upazila under Mymensingh District. For the evaluation of medical waste management capacities, 1 government hospital and 7 private diagnostic centers of Ishwarganj Upazila were selected. Data were collected from total 78 respondents, among them 34 patients, 8 administrative officers, 2 doctors, 15 technicians, 12 cleaners and 7 nurses to inspect the presented medical waste management, level of awareness and training of the individuals involved in the hospital premises. In Addition, data were collected from each Health Care Establishments (HCEs) to quantify waste generation rate that found to be 1.08 kg-1bed-1day-1 and 0.31 kg -1patient -1day-1. The percentage of reusable waste, sharp waste, infectious waste, general waste and chemical and radioactive waste generation were 11.3 per cent, 10.75 per cent, 9.13 per cent, 67.5 per cent and 1.5 per cent, in that order. In this study, respondents provide their outlook in relation to nearby discarding places of waste in open dumping at Kachamatia river site (very inimical for river ecology), pits, municipal dustbin and others respectively 50.68 per cent, 30.14 per cent, 10.16 per cent and 8.22 per cent of total respondent. About 30.5 per cent respondents stated as adequate of existing hospital waste management, rest 69.5 per cent stated as inadequate. In the statistics of getting training, 35 per cent staffs got training and 65 per cent staffs did not get training on sustainable medical waste management strategies. In relation with the training methods 64.5 per cent respondents showed their interest in video and lecture method, 19 per cent for video, 11.5 per cent for lecture and 6 per cent for other methods. This paper explains the importance of sustainable treatment of medical waste for nature-ecology nexus. Finally some recommendations are provided for superior management of medical wastes. The scenario of medical waste management in different types and category of hospitals are not satisfactory where polluting the environment with toxic substances contributing to public health problem. Bangladesh has so many public hospitals, medical college hospitals, district hospitals and upazila health complexes. Moreover, a good number of private hospitals and clinics are also providing health care services. In the majority public and private hospitals there are no systemic approaches to medical waste disposal. The Ministry of Health and Family Welfare (MOH and FW) already started to address the medical waste management as one of the priority program by including it as one of the critical area among the identified six critical areas under health, nutrition and population sector program. In Bangladesh, the rapid increase of hospitals, clinics, diagnostic laboratories etc. in Mymensingh district exerts a tremendous impact on human health ecology. About 5 per cent of the total population in Bangladesh is thought to suffer from chronic hepatitis B infection. Most of the clinical wastes (e.g. syringes, needles, saline drips, discarded food, gauze, vials, and ampoules) are collected by women and children who re-sell those despite of the deadly health risks. However, the fundamental objectives: To investigate the existing management status of hospital wastes in the study area; To observe the level of knowledge and awareness of individuals involved in the hospital premises; To suggest remedial measures for better management of medical wastes in the study area. The study was conducted in some of the Health Care Establishment (HCEs) belonging to the Ishwargonj upazila under Mymensingh district. They are Ishwarganj Upazilla Health Complex (IUHC), Emdo Diagnostic Centre (EDC), New Incaf Diagnostic Centre (NIDC), Buda Diagnostic Centre (BDC), Modern Diagnostic Centre (MDC), New Lab Diagnostic Centre (NLDC), Apon Diagnostic Centre (ADC), and Sheba Diagnostic Centre (SDC). One Government hospital and seven private diagnostic centers were selected as the sample points. Primarily, it includes Medical waste categorization clinical waste, laboratory waste, Non-clinical waste and kitchen waste. A large storage size is required for a communal container, while an individual storage is sized to accommodate the waste generated by a family for normally two or three days. The ultimate disposal of waste including those wastes collected and transported directly the residual substance from various waste processing plants that are of no further use. The options available for disposal are Open dumping, sanitary land filling and Incineration. The respondents provided information from their practical experience. In order to minimize the response error questions were asked in simple Bengali language. After completion of each interview, it was checked to be sure that information had been properly recorded. Blood bags, saline bags, syringe, bottle of medicine, plastics materials etc were categorized as reusable medical waste. Among the HCEs, Ishwarganj Upazilla Health Complex (IUHC) generated the lowest 7 per cent of reusable waste, Emdo Diagnostic Centre (EDC) generated second highest (13 per cent) percent of reusable waste, New Lab Diagnostic Centre (NLDC), Buda Diagnostic Centre (BDC) generated 10 per cent reusable waste, Modern Diagnostic centre (MDC) generated 11 per cent reusable waste, New Incaf Diagnostic centre (NLDC) generated 12 per cent reusable waste, Apon Diagnostic Centre (ADC) generated 12 per cent reusable waste, and Sheba Diagnostic centre (SDC) generated highest 14 per cent of reusable waste. In the studied HCEs total 73 respondents provide their opinion about existing disposal place of waste in collection system. Among them 37 respondents preferred dispose their waste in open dumping at Kachamatia river site; they were 50.68 per cent of total respondents.22 respondents preferred dispose their waste in pits and they were 30.14 per cent of total respondents.8 respondents preferred dispose their waste in municipal dustbin and they were 10.16 per cent of total respondents, rest 6 respondents preferred dispose their waste in others, they were 8.22 per cent of total respondents. In the studied HCEs total 73 respondents provide their opinion about time of waste collection from secondary source to final disposal place. Among them 42 respondents preferred morning about time of waste collection from secondary source to final disposal place; they were 57 per cent of total respondents.18 respondents preferred noon and they were 25 per cent of total respondents. Rest 13 respondents preferred random time and they were 18 per cent of total respondents. The field survey shows different levels of awareness from different respondents. In the measurement of getting training of the studied HCEs, 35 per cent staffs got training about the hospital waste management and 65 per cent staffs did not get training of the total respondents. The research focuses generation and the existing management system of medical wastes in hospitals and diagnostic centers in Ishwarganj upazila. The level of awareness on medical waste is medium but they are not able to manage the waste systematically since there are lacking of systems, rules and regulations, and financial support. Recommendations are given below: Raise awareness and education on medical waste issues, segregation of medical waste should be done at the point of generation. Different colored bags should be used for collection of hazardous and non-hazardous waste, modem techniques and technological devices such as moving dustbins, crane, separate collection system bins etc should be used in hospital waste management system, To avoid the risk of health effect from the wastes on-site incineration of the entire hospital waste with appropriate air pollution controls, is the best available means of processing prior to disposal, Re-use, recycle and reduce of waste generation should be followed through composting and following other process, To minimize the generation of medical waste, good housekeeping, replacement of chemicals, etc. may be adopted, Training programme on safe handling of medical waste can be organized for medical staff, Government should promulgate and implement laws and regulations regarding medical waste management, A strong monitoring system should be developed to monitor the whole management system. Shishir Reza is Environmental Analyst, Bangladesh Economic Association Sharmin Akter, Urban Planner, Bangladesh Institute of Planners