HEALTH CARE WASTE

MANAGEMENT IN
BANGLADESH:
A SUSTAINABLE GUIDELINE
 
Mohammad Ali and Dr.Md.
Jahir Bin Alam
Undergraduate Student,
Assistant Professor
Department of Civil & Environmental
Engineering
Shah Jalal University of Science & Technology, Sylhet,
 INTRODUCTION
What is Health Care Waste or Clinical Waste?
Health-care waste is defined as the total waste stream (solid and liquid) from health-
care establishments, research facilities and laboratories.
According to World Health Organization (WHO) approximately
 85% non-hazardous
 10% are infectious
 around 5% are non-infectious but hazardous

Background & Reasons for Action

 The infectious parts of the HCW present a risk of spreading infection if not
handled properly.
 Used chemicals and outdated pharmaceuticals pose a health and environmental
risk
if not handled, treated and disposed of properly.
 Treatment of HCRW, as well as the decomposition of some already treated HCRW,
may emit environmentally harmful substances to the atmosphere.
 Pathological HCRW not properly controlled and managed, which creates
strong opposition from the public.
 Untreated HCRW or residuals of treated HCRW disposed of at landfills may
generate leachate that can pollute the surface and groundwater as well
as the surrounding soil, if the landfills are not operated properly.
 
PUBLIC HEALTH RISKS OF HAZARDOUS HCW
POTENTIAL HEALTH EFFECT

Certain infections, however, spread through other media or caused

by more resilient agents, may pose a significant risk to the general
public and to hospital patients.

The diseases due to mismanagement of hospital wastes are

√ AIDS √ Gastroenteric infections
√ Respiratory infections √ Blood stream infections
√ Skin infections √ Effects of radioactive substances
√ Intoxication √ Hepatitis B and C

In the healthcare sector alone, the according to WHO unsafe

injections cause approximately
√ 30,000 new HIV infections
√ 8 million HBV infections
√ 1.2 million HCV infections worldwide every year.
PRESENT HEALTH CARE WASTE SITUATION
IN BANGLADESH

✞In most government hospitals, private laboratories, and clinics waste was
disposed in municipal bins without proper regard to the harmful effects they
may pose to human health and environment.
✞City Corporation and Municipalities do not have a separate system for medical
waste or infectious waste collection.
✞Varieties methods were used by the medical facilities for medical waste
disposal. Which include
↔incineration   ↔open burning ↔burial selling
↔dumping ↔reuse ↔removal by municipal trucks
↔Syringes, vials, empty packets, bottles and saline bags, used X-ray film-
developing chemicals were some of the items collected un-safely and re-
sold.
✞There are few initiatives taken by NGOs for medical waste collection, disposal
and training of hospital staff in a pilot scale.
✞The Ministry of Health and Family Welfare and DOE is working separately on
this issue.
LAWS, POLICY AND TECHNICAL GUIDELINES IN HEALTH
CARE SECTOR IN DEVELOPED COUNTRIES
National law should consist of Clear definitions, Defined
responsibilities, Duty of Care of waste producer, Tracking systems
and record keeping, Defined penalties, Regulatory and enforcement
systems.
For Clear definition some laws should be stablish. The laws are
Framework Law on Environmental Protection, including
environmental permitting, Law on Air, Law on Water Protection, Law
on Nature Protection, Law on Waste Management.
The policy document should be contained
(i) Description of health and safety risks
(ii) Reasons for safe and sustainable health-care waste management
(iii) Description of approved methods of waste minimization, handling
and disposal
(iv) Record keeping and documentation
(v) Training
(vi) Health and safety protection rules etc.  
HEALTH CARE WASTE LAW IN BANGLADESH
According to the Bangladesh Environment Protection Act 1995, there is
no law for HCWM and specific legislation pertaining directly to the
handling, transportation or disposal of medical waste.
HEALTH-CARE WASTE MANAGEMENT
PLANNING
The need for planning
International recommendations for waste management
• Prevent and minimize waste production.
• Reuse or recycle the waste to the extent possible.
• Treat waste by safe and environmentally sound methods.
• Dispose of the final residues by landfill in confined and carefully
designed sites.

National plans for health-care waste management

➼ A national management plan will permit health-care waste
➼ Management options to be optimized on a national scale.
➼A national survey of healthcare waste will provide the
relevant agency with a basis for identifying actions on a
district, regional, and national basis, taking into account
conditions, needs, and possibilities at each level.
➼An appropriate, safe, and cost-effective strategy will be
concerned principally with treatment, recycling, transport, and
disposal options. The seven steps of WHO can also be follow for
national program.
Basic Steps in Health Care Waste
Management in Minimal Programmes

Assign Classify & Assess Identify Adequately treat&

Responsibilities Waste Generation Reuse options dispose of wastewater

Train personnel & Ensure safe Ensure worker’s Improve stock management of
waste workers storage safety chemicals & pharmaceuticals

Return outdated drugs or chemicals

Recycling of selected to the supplier
Wast e Segregat ion
materials
General waste joins the municipal
waste stream
Treatment & Disposal of health-care waste

Treatment
Incineration, on-s ite or off-s ite-open-air burning, Chem ical dis infection, Autoclaving of highly infectious
was te, Encapsulation Dis infection of stools from cholera patients & of oth er infectious Bodily fluids

Final Disposal
Municipal landfill, Burying or Premises
Discharge into sewer
GUIDANCE FOR MUNICIPAL HEALTH CARE
WASTE MANAGEMENT

This section deals with centralized healthcare waste management,

which are often components of broader municipal solid waste
management of the regional authority.

Central waste facilities at the municipal or regional level offer

☛ They are more cost effective through economies of scale
☛ Provision of spare capacity is more economical
☛ Future modification or expansion is less expensive
☛ Operations are more efficient
☛ Reduction of emissions is more effective
☛ Monitoring and supervision are easier than for dispersed facilities
☛ Environmental monitoring and control are easier
☛Healthcare facility administrators can devote their full attention to the
primary activities of the healthcare facility.
CONCLUSION & RECOMMENDATION

>Medical waste management is not a priority issue in Bangladesh.

>Improvement in healthcare waste management involves a number of
activities, which can be undertaken as a series of small step.
>There is no ‘one stop’ technical solution. Considering the situation in
developing countries and field observations, recommendations for
medical waste and infectious waste management are as flows:
National policy for safe health-care waste management is
(i) Development of an enforcement mechanism
(ii) Setting of practical targets or objectives over a specified time period
(iii) Establishment of a national and regional infrastructure for health-care
waste disposal
(iv) Support of regional and municipal authorities in implementation
(v) Integration of waste minimization into national purchasing policies
(vi) Routine monitoring of impact through process indicators (number of
health-care establishments with safe waste management systems)
and outcome indicators (e.g. number of accidents involving health-
care waste).
CONCLUSION & RECOMMENDATION
> Improving Municipal Waste Management as well Health Care Waste
Management is a necessity for Bangladesh. To make medical waste
management a successful one following activities should be done:
> Formulation and implementation of laws, regulation and guidelines.
> Integrate environment concerns into the National Health policy.
> Incorporate environmental issues in Health Education Curriculum.
> Ensure a healthy workplace for workers.
> Awareness building of hospital staff and the public about the risk involved and
the proper procedures.
> Proper in-house management: identification and segregation of material.
> Institution cooperation must be increased between hospitals. Larger hospitals
may share their facilities with smaller clinics. Government bodies must also
collaborate (e.g. City Corporation, DOE) to find solutions for proper
management.
> Central incinerators reduce air pollution and are cost effective.
> Involvement of local community and stakeholder in planning and implementing
the project is a successful on establish by Prodipon and HLSP in Bangladesh;
> Use of simple segregation, collection and disposal as well as low cost
technology to store, treat and dump medical waste centrally.
CONCLUSION & RECOMMENDATION

> Use of disinfectants before disposal of infectious waste to the bin is a good
practice.
> Once a waste management plan is made and is implemented in a hospitals, it
should be a sustainable one.
> A program for improving education, training and raising awareness about the
adverse effect of improper disposal of medical waste for all stakeholders.
> Initiation of programs at different hospitals to ensure that proper handling and
separation of medical waste takes place before disposal. This should include
training of all waste handlers.
> Inclusion of medical waste management in the curriculum of medical and
nursing colleges.
> Efficient separation and labeling of hazardous waste; this reduces the total
volume of hazardous waste and hence reduces the subsequent specialized
disposal.
> Create a dedicated budget line for waste management.
> Autoclave Infectious Waste and dispose as normal waste. It might be cheaper,
easier to operate, less operation and maintenance cost, no pollution.
Thank You All