HOSPITAL WASTE MANAGEMENT: BANGLADESH

Tarannum Dana a
a
Department of Population Science, Social Science Faculty, University of Dhaka, Bangladesh.
a
Corresponding author: [email protected]

© Ontario International Development Agency. ISSN 1923-6654 (print)

ISSN 1923-6662 (online). Available at http://www.ssrn.com/link/OIDA-Intl-Journal-Sustainable-Dev.html

Abstract: Hospital waste is infectious and hazardous community level clinics and about 1449 outdoor health
which poses serious threats to environmental health and facilities at Union level that falls under DGHS [1]. From
requires specific treatment and management prior to its the same study it was also found that at district level
final disposal. Appropriate and safe management of there are about 117 hospitals that are currently
healthcare waste is acknowledged globally. WHO and functioning [1]. Among the private hospitals there are
Environmental Protection Agency (EPA) have about 2501 registered hospitals and 5122 registered
emphasised the need to handle and dispose of hospital diagnostic centre throughout the country [1]. In addition
waste from the healthcare establishments in proper there are many clinics, including about 5000
ways. City Corporations are responsible for solid waste government and NGO run clinics, and doctor’s
management in the country. However the collection of chambers where health care waste is generated. In
the waste is often irregular, leading to unsanitary Dhaka City alone there are about 1200 hospitals, clinics
conditions near the primary collection points. Many and diagnostic centres [2]. According to Dhaka City
towns do not have the capacity to collect all the waste, Corporation (DCC) research report, waste generated per
and often proper sanitary disposal is problematic. In person per day is about 0.5kg. In the same report it was
Bangladesh hospital waste management is growing with identified that 3700 metric tons of wastes are generated
an ever-increasing number of hospitals, clinics, and per day in Dhaka City, of which about 200 tons are
diagnostic laboratories especially in Dhaka City. Thus hospital waste and 40 tons are infectious waste [3]. The
healthcare waste management is neglected and it falls amount is increasing every day, with rising number of
under the auspices of the local municipal bodies which medical establishments where wastes are not managed
are responsible for the collection, removal and disposal properly. The fact that knowledge on the means of
of different kinds of wastes from public places. This segregating hazardous and non-hazardous waste is low,
paper aims to discover and understand the current it is difficult to secure proper information upgrading the
situation of healthcare waste management that includes actual amount of waste that is generated every day. In
waste handling, collection and disposal as well as the different countries World Health Organisation (WHO)
knowledge and awareness level of individuals involved and Environmental Protection Agency’s (EPA) have
in healthcare. Furthermore, the paper also explores emphasized the need to handle and dispose medical
alternative options for the management of hospital wastes in properly. In Bangladesh hospital waste
wastes that is environmentally friendly. Research on this management which falls under the auspices of the
critical issue has been very limited, and there is a municipal bodies is being neglected. The Municipal
serious shortage of information which is essentials for authorities are responsible for the collection, removal
strategic for planning. and disposal of different kinds of medical wastes from
public places to the dumping grounds; naturally
Keywords: collection, disposal, hospital waste,
standing they are not efficiently handling the matter.
management, segregation, treatment
Until recently, the management of medical wastes
INTRODUCTION received little attention despite their potential
environmental hazards and public health risks. The

T he main purpose of any health care institution is

to provide health services to people who are
suffering from various kinds of illnesses. Hence
it is important to keep health centres clean and
environmentally sound. Ironically, most of the health
paper attempts to identify the waste management
practice in the country along with the reasons for waste
management failure.
MEDICAL WASTE
care centres especially those that are run by the
The wastes that are being generated from hospitals,
government in Bangladesh are in poor condition unclean
clinics or institutions that provide healthcare services
and polluting the environment with high toxic
are commonly known as hospital waste or medical
substances. In Bangladesh these hospitals/clinics are
waste. The hospitals produces a wide variety of medical
causing serious environmental problems for
wastes ranging from general waste (like food waste,
communities and the people who works are in these
paper waste) to hazardous biological, chemical and
places. Therefore management of hazardous hospital
radiological wastes [4]. In a broad term medical wastes
waste is a growing concern in Bangladesh. The country
can be of two types shown in the following figure 1:
has some 460 Upzilla level Hospitals and 9722
 30 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

Non- Hazardous
Waste (80-85%)

Hospital Waste Sharps

Infectious waste Solid

Non-sharps
Hazardous Waste Liquid
(15-20%)
Chemicals &
Pharmaceuticals
Non-infectious waste

Infectious waste
Source: WHO, 2001, [5]

Figure 1: Different Types Hospital Wastes

Table 1: Different Categories of Hospital Wastes with Examples

WASTE CATEGORY Description with Examples

Infectious waste Pathogens may be present. E.g. excreta, laboratory cultures, tissues, materials or equipment that
have been in contact with infected patient.
Pathological waste Human tissues or fluids. E.g. blood and other body fluids, foetuses.
Pharmaceutical waste Wastes containing pharmaceuticals. E.g. pharmaceuticals that are no longer needed or expired
Genotoxic waste Waste containing substances with genotoxic properties. e.g. waste containing cytotoxic drugs
(often used in cancer therapy); genotoxic chemicals.
Chemical waste Chemical substances present in a waste. E.g. laboratory reagents, film developer; disinfectants
that are expired or no longer needed; solvent.
Wastes with high content Batteries, broken thermometers, blood-pressure gauges.
of heavy metals
Pressurized containers Gas cylinders, aerosol cans
Radioactive waste Radioactive substances present in a waste. e.g. unused liquids from radiotherapy or laboratory
research, contaminate glassware, packages or absorbent paper.
Sharps Sharp wastes. E.g. needles, knives, blades, broken glass infusion sets.

The composition of medical wastes varies from country the quantities produced. The minor sources are scattered
to country even within a country as it depends on the that produces similar kinds of waste as major sources
type of health services they are providing to the people. but these waste does not contain radioactive wastes, no
The following table 1 [6] shows the wastes that are human body parts and among the sharps they consist
commonly found in all the hospitals all over the world. mainly of hypodermic needles [7]. An attempt has been
made to demonstrate the sources below in figure 2:
Sources of Medical Waste: The sources of medical
waste can be grouped as major and minor according to
 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011) 31

Sources of Hospital Wastes

Minor Sources Major Sources

Small healthcare establishment: Hospitals: -University hospitals

-Physicians’ office -General hospitals
-Dental Clinics -District hospitals
-Acupuncturists Other Healthcare establishments:
-Chiropractors -Emergency medical care services
Specialised healthcare establishments and institutions with -Health-care centres and dispensaries
low waste generation -Obstetric and maternity clinics
-Convalescent nursing homes -Outpatient clinics
-Psychiatric hospitals -Dialysis centres
-Disabled persons’ institutions -First-aid posts and sick bays
Non-health activities involving intravenous -Long-term healthcare establishments and hospices
-Cosmetic ear-piercing and tattoo parlour -Military medical services
-Lllicit drug users Laboratories and research centres
Funeral services Mortuary and autopsy centres
Ambulance services Animal research and testing
Home treatment Blood banks blood collection services

Figure 2: Sources of Medical Wastes

Effects of Medical Waste Respiratory infectious (c) Urinary tract infection (d)
Skin infection (e) Meningitis (f) Viral Hepatitis A, B
The poor management of medical wastes is an obvious
and C (g) Tetanus
risk to people and the environment as they contains
infectious agents, genotoxic materials, toxic or There are numerous other diseases, which could be
hazardous chemicals or pharmaceuticals and sharps transmitted by contact with health-care wastes. The
microorganisms, which enter the human body via a hazardous nature of hospital waste may be due to one or
number of ways and cause diseases. These risks have so more of the characteristics that cause health risk in
far been poorly investigated. Waste and by-products can different ways shown in figure 3 [9]. There are many
also cause injuries, for example radiation burns or people who are at risk directly and indirectly as they
sharp-inflicted injuries; poisoning and pollution, come in to contact with the medical waste while
whether through the release of pharmaceutical products, handling the waste. The public may also come in to
in particular, antibiotics and cytotoxic drugs, through contact as they are thrown in to open places or carried
the waste water or by toxic elements or compounds such environment by air and water. In this process of medical
as mercury or dioxins [8]. The common diseases waste management the people who are at risk are shown
connected are: (a) Gastroenteric infectious (b) in figure 4 [10].
 32 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

Figure 3: Different Kinds of Risk Associated with Hazardous Health-care Waste

Hazardous health care waste and health risk

 it contains infectious agents
 it is genotoxic
 it contains toxic or hazardous chemicals or pharmaceuticals
 it contains sharps

Occupational risk Risk to the public Indirect risks via the environment

During handling of wastes, health- The reuse of syringes by the general In addition to risks from direct contact with
care personnel and waste workers public represents one of the greatest health-care waste, waste can also
may come in contact with waste-if public health problems in the contaminate the environment, such as the
it hasn’t been packaged safely. developing world related to health- water or the air and so indirectly impact on
Many injuries occur because care waste. Worldwide, an estimated health.
syringe needles or other sharps 10 to 20 million infections of Hepatitis
B and C and HIV occur annually from When wastes are disposed of in a pit that is
have not been collected in safety
the reuse of discarded syringe needles not lined, the groundwater may become
boxes, or because these have been
without prior sterilisation. contaminated. As the same groundwater may
overfilled. Also, contact with other
If health-care waste is dumped on un- be used as a resource for drinking water,
infectious waste that has not been
controlled sites or in other areas, wastes may indirectly impact on health via
packaged or treated adequately
which the public, the public, can the water. If waste is burned or incinerated in
may cause a risk. On landfills or
access, and in particular children can an incinerator, which does not have an
waste dumps, waste recyclers or
come in contact with infectious emission control (which is the case with the
scavengers may come in contact
wastes. Also the contact with toxic majority of incinerators in developing
with infectious wastes if the waste
chemicals, such as disinfectants, may countries), the air may become contaminated
has been disposed of without prior
cause accidents when they are by a large number of pollutants and cause
treatment.
accessible to the public. serious illness in people who inhale this air.

Figure 4: Persons at Risk

Doctors, nurses,
health-care
auxiliaries
Patients in health- Hospital
care maintenance
establishments personnel
Persons at risk

Workers in waste Visitors to

disposal & health-care
scavengers establishments
Other workers
such as laundries,
waste handling
&transportation
 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011) 33

The people are exposed to the diseases of patients, as

technologies and new management systems for their
the public hospitals do not provide them with proper
health-care waste management. At present these nations
equipment and facility. The nurses, sweepers and
are addressing the waste issues in more environmental
cleaners are not aware of precautionary measures while
friendly manner. The monitor and evaluate their systems
disposing of the hazardous hospital/clinical waste. The
everyday with new technologies and developing new
scavengers outside the hospitals are exposed to the
policies. In Bangladesh, proper medical waste
hospital/clinical waste, as the waste is disposed into the
management is a new phenomenon and the government
City Corporation dustbin. Studies have not been carried
is trying to develop a new and modern approach to deal
out on the health effects of the community or on those
with the medical waste properly. There is no national
who are exposed to the hospital/clinical waste in
policy on medical waste management in Bangladesh.
Bangladesh. According to Akter [11] there were reports
For a proper and scientific management of medical
of different injuries of injury due to exposure to medical
waste, the government should give priority to
wastes inside or outside of hospital premises such as,
formulating a policy. Moreover, the existing laws are
hands cut, skin diseases, ulcers and injuries by needle.
outdated and impose by low penalties and sometimes,
MEDICAL WASTE MANAGEMENT no penalties for offenders. Thus, massive awareness on
this issue and new tougher laws could be effective in
Broadly waste management means, managing the waste
protecting people and the environment from deadly
from the place it is generated till the ultimate disposal.
medical waste. Recently a law has been proposed to
According to Rushbrook, [12] defines hospital waste
handle medical waste properly, but it needs to be
management as below: Good management of health
adopted and enforced as soon as possible. The
care waste in hospitals means the effective segregation
department of Environment has developed a Hospital
of waste and the separate handling and disposal of each
Waste Pocket Book in 2004 which was revised in June
segregated waste category. This cannot be achieved
2010 [13]. This book is supported by Medical Waste
without the commitment of senior directors and the
Management Rules 2008 [14]. The Pocket book
motivation of medical and support staff.
includes all the standard procedures for proper
The main goal of bio-medical waste management is to management system for all health care establishments.
protect the public health; promote the quality and The book clearly indicates types of hospital waste along
sustainability of environment and to support the with the colour codes for waste segregation.
economic productivity. Health-care waste management Responsibilities of individuals who handle the wastes in
is now an important agenda throughout the world both the hospitals are explicitly described. It also includes
in developed and developing countries. To achieve ways in which the waste should be transported and
appropriate health-care waste management, which is stored the hospital premises. This guide represents best
environmentally friendly as well economically viable practice and ensures, at minimum, compliance with
for every country especially for the developing countries current regulations. However it does not include an
is now the primary concern. According to WHO [7] any appropriate, safe, and cost-effective strategy and only
formulation of objectives and planning for their concerns itself with treatment, recycling, transport, and
achievement are important for improving health-care disposal options.
waste management at the national, regional, and local
In Bangladesh the healthcare centres like hospitals,
level. Agenda 21 recommends a set of measures for
clinics, nursing homes, dental hospitals etc have
proper waste management that is summarised as below
inadequate waste management systems which is a threat
[6]: (a) Prevent and minimise waste production (b)
to public health as well as to the environment [15].
Reuse or recycle the waste to the extent possible (c)
Neither the government nor hospital authorities pay
Treat waste by the final residues by landfill in confined
proper attention to this matter. Almost every
and carefully designed sites.
hospital/clinic is disposing both non-hazardous and
Therefore proper management of hospital waste requires hazardous wastes in the nearby municipality dustbins or
achieving the goal of minimizing health hazards and roadside without any sort of treatment. As a result an
making the hospital environment friendly. World Health unhealthy and hazardous environment exists in and
Organisation [8] provides guideline for all hospitals to around the hospitals that are affecting the patients,
comply with in order to ensure safe medical waste hospital staffs and other people who are exposed to
management. These are (a) Waste Minimisation at these conditions. A study in 2005 [16] reveals that
source by reuse, recover and stock management; (b) improper procedures of medical waste management
Waste Segregation by categories and sharps; (c) Waste exist in the country. It also found that some of the
Identification by colour coding for different wastes; (d) hospitals separate infectious wastes from the non-
Waste Collection and storage by routine programme; infectious waste stream at the site of production, but
(e) Waste Transfer by following “chalked Path way during disposal it is done in municipality dustbins where
from generation to disposal sites and use enclosed the wastes were mixed together [16]. The following
vehicle (f) Treatment Option by both burn and non- figure 5 shows commonly practiced hospital waste
burn ways: management system in Bangladesh [17].
The countries in the north have already adopted new
 34 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

Figure 5: Practiced Hospital Waste Management System in Bangladesh

Collector and Existing Situation

Sources, Collection and Disposal of bio-medical waste Handler

Operation Theater Sewerage

Collected in open
Collection bins without disinfection
Patient (Infectious +
Service Store & Nurse/ Ward Non-infectious)
Pharmacy boy / Aya / No segregation
Cleaner/ No labeling of bins
Support On-Site
Administration Tokai (Waste Segregation No color coding of bins
Service Collection Sorting of used disposables
pickers)
System without disinfection

House
Sewerage
Keeping Used plastic and glass, IV
Recycling bottles infusion sets, sharps,
Pathology & (at source) syringes are sold to third party
Laboratory

Disinfecting
Sewerage Sewerage
Activities

Manually transported
Transportation No safety precautions

Disposal on roads/open pits

No fencing to keep waste pickers away
Collection System O Health impacts
of Municipality On-site Disposal Municipality /
ite Disposal Tokai (Waste Recycling of waste by waste pickers
pickers)

Air pollution
Toxic ash
Municipal Disposal
Site Open Burning Municipality /
Recycling of waste by waste pickers
Tokai (Waste Unsafe disposal
pickers) Unaesthetic conditions
Odour nuisance
Ground water pollution
 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011) 35

Figure 6: Hospital Waste Management System by PRISM Bangladesh

There are only three NGOs in Bangladesh that are the guideline in both public and private hospitals/clinics.
actively working in the field of hospital waste Out of reasons for not being able to implement it
management. These NGOs are PRISM (Project in successfully is that authorities and owner of
Agriculture, Rural Industry, Science and Medicine) hospitals/clinics are not aware of the effects on the
Bangladesh in Dhaka city, BASA in Tongi and environment and people. They also lack interest and all
Shawpno in Bagura. They are collecting the waste from not bothered to improve or update their disposal
the hospitals with a nominal service charge. Among the methods as there is a cost involved. Thus there are only
three NGOs, PRISM Bangladesh along with DCC is few people who are aware of the issue but they are
properly collecting and treating the hospital waste up to outnumbered for which they cannot take any steps to
final disposal. There are only 342 hospitals, clinics and improve the situation. Moreover the staffs who are
diagnostic centres under PRISM Hospital waste handling wastes are illiterate and results have little
management programme (In conversation with PRISM). knowledge about the impact. In private hospitals/clinics
Rest of the healthcare institutions follow their own or the nurses dispose of wastes according to the
old system. The following figure 6 shows existing waste management instruction of the hospital. As a result the
management practice in some health care establishments staffs are not aware and responsible for executing the
organised by PRISM Bangladesh [16]: proper way in which of hospital waste should be
discarded. Institutions that are aware are don’t have
Majority of the hospitals, clinics and diagnostic centres
proper management system and guidelines. On the other
in the country do not have any waste management
hand the actual problems observed in both public and
treatment plant nor do they give proper attention to the
private hospitals/clinics and diagnostic centres are: (a)
problem of hospital waste management. Till today, all
No alternative methods for safe disposal (b) No system
the hospitals discharge their liquid pharmaceutical and
for segregating the waste before disposal (c) No specific
chemical waste into the general sewers or drains
regular awareness programme among all staff (d) No
because none of them have any proper liquid waste
protection for waste handlers, which are often infectious
management system. Liquid waste is mainly generated
and potentially dangerous (e) No specific training
from patients' service units, operation and surgical units,
program for the nurses and cleaners regarding waste
laboratories and other health-care units. As a result, the
handling, disposal or management.
water bodies in Bangladesh are being polluted by the
liquid wastes. The hospital waste management practices somehow
have not been given appropriate attention and
WASTE MANAGEMENT FAILURE
importance in Bangladesh for which it has not been
Hospital waste management in Bangladesh needs to be successful in achieving better medical waste
stressed as it is causing serious damage to both our management. Other problems include: (a) Lack of
health and environment. Despite having a hospital waste implementation of guideline (b) Existing gaps within the
management pocket book since 2008, the government waste management rule 2008 (c) Problem in
has not been successful to ensure the implementation of Environmental Act 1995 (d) Lack of interest and unity
 36 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

Basic Conditions Unmet Practical Basic Health

Requirements Implications Conditions Affects

No sense of
responsibility
Lack of
awareness of
health risk
Insufficient
national policy
and regulations Uncontrolled
scavenging
Lack of Inadequate waste
political system
commitment Insufficient
allocation of
resources Blood-borne
infections
Inadequate
protection of
Lack of workers
evidence for
certain Insufficient access
subgroups to information Effects from
Inadequate exposure to
training of staff or toxic
waste workers Reuse of pollutants
disposables
Poverty
Lack of safe low
cost options

Figure 7: Interference of Causes and Effects of Inadequate Waste Management

 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011) 37

(e) Economic constrains (f) Following the old

the Department of Environment, Ministry of
management (g) Corruption of the lower level (h)
Environment and Forests categorize hospitals and
Hazardous waste management is not high in the political
clinics with other industries, saying that hospitals and
agenda (i) Lack of responsibilities and supervision (j)
clinics should be built only in non - residential areas, a
Inadequate enforcement of existing pollution control
directive which is hardly followed. The existing
laws.
environmental law is too generic and it is clear that
According to Mobarak [18], private hospitals and clinics clinical waste requires separate environmental
are better off than public hospitals/clinics because in guidelines. The City Corporation Act and the Urban
public hospitals autocracy is practiced where policy Local Government Ordinance does not cover medical
makers are not interested to improve the hospital waste management.
environment and follow the waste management
Some actions have however been taken. Very recently, a
procedures even if they are aware about it. He also said
bill was prepared by the MoEF for amendment of the
that the management of public hospitals is very poor as
old ordinance for issuing licenses for private practice as
bureaucratic red tape plays a major role. According to
well as for establishing new private health care centres
the Conservator Officer of Dhaka City Corporation
and to control hospital waste. A committee was formed
(DCC) treatments in private hospitals and clinics may be
at the initiative of the Department of Environment
good but the waste disposal procedure is nothing
involving representatives from relevant government
different from the public hospitals. According to Dana
agencies and other stakeholders. Under the Sustainable
[19], the main problem is the lack of awareness at all
Environmental Management Programme (SEMP), there
levels in this occupation and the management plan is so
is provision of review and amendment for a range of
poor that hospital/clinical wastes are mixed with general
environmental laws. The Department of Environment
wastes. According to PRISM the major reason for not
has outlined a guideline for medical waste management
being able to achieve a successful management system
Rules 2008.
are: (a) First there is a system for medical waste
management but no implementation (b) No effective National law should consist of clear definitions, defined
measures taken by the authority to ensure that hospital responsibilities duty of care of waste producer, tracking
follow the guideline (c) No provision of quantifying and systems and record keeping, defined penalties,
record keeping on waste or any accident occurred (d) regulatory and enforcement systems. For clear
Some hospitals segregates waste in house but dumps definition some laws should be enacted. The laws are
together in DCC bin. (e) No provision for regular Framework Law on Environmental Protection, including
training and awareness among the staffs environmental permitting, Law on Air, Law on Water
Protection, Law on Nature Protection, and Law on
The failure in hospital waste management has deeper
Waste Management. The policy document should
implications than those mentioned above there is a
contain the following issues: (i) Description of health
generalized lack of interest in addressing waste
and safety risks (ii) Reasons for safe and sustainable
management and in introducing safer healthcare waste
health-care waste management (iii) Description of
management system [20]. In addition there are no
approved methods of waste minimization, handling and
appropriate regulations, or is there any enforcement. An
disposal (iv) Record keeping and documentation (v)
essential issue was is the clear attribution of
Training
responsibility of appropriate handling and disposal of
waste. According to the ‘polluter pays’ principle, this EFFECTIVE MANAGEMENT SYSTEM
responsibility lies with the waste producer, usually
The generation of medical waste in Bangladesh has been
being the health-care provider, or the establishment
increasing in quantity and variety due to the wide
involved in related activities [8]. WHO [8] provides that
in addition to the lack of political will to develop and acceptance of single-use disposable items. In the recent
implement a proper management system as it plays an past, medical waste was often mixed with household
waste and disposed of in municipal solid waste landfills
important role on the management of health care wastes.
[16]. Time has come that we need to give priority to
The main relations between causes and effects are
medical waste management in Bangladesh. Therefore
outlined in figure 7 [8]:

POLICY GUIDELINES AND LEGAL ASPECTS

for the improvement in hospital waste management
The Medical Practice, Private Clinics and series of small steps involved, which can be undertaken
Laboratories (Regulation) Ordinance, 1982, gradually. Since there is no ‘one stop’ technical solution
amended in 1984, says nothing in particular about considering the situation in Bangladesh to have
medical waste management. It describes some effective management system the things we need to do
criteria for obtaining a license to establish a hospital first are as follows [21]: (a) Appoint a Hospital Waste
or clinic, but this merely states the necessity for Supervisor and allocate resources (b) Assess type and
proper accommodation with hygienic environment. quantity, appraise current handling methods, evaluate
treatment and disposal facilities (c) Encourage safe
The Environment Policy, 1992, Environment Protection practices throughout the different stages of the waste life
Law, 1995 (2000), Poribesh Adalat Ain, 2000; and the cycle (d) Require to regular training sessions for all staff
Environment Conservation Rules, 1997 formulated by
 38 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

Figure 8: Step-by-Step Approach for Medical Waste Department

Step 3-Transmission routes for infectious from health-

Step 1-Establish a three-bin system within Step 2-Colour coding
care waste
the Hospital premises According to WHO for general waste it should
All the transmission routes of infectious wastes are caused
be black and yellow for infectious wastes
by sharps contaminated wastes it is therefore necessary to
-General health-care waste colour bags and containers must be used that
put all the sharp wastes into a box or container not in a
-Potentially infectious health-care waste will be easily identified.
plastic bag that can easily punctured
-Used sharp waste

Step 6-Bag filling Step 5-Fixed collection schedule Step 4-Different locations for black and yellow waste
To avoid any sorts of splitting that may cause There should be schedules for collection of wastes bags
injuries therefore it should the bags and containers and at least once a day from each department. There Both types of waste collecting bags needs to be placed in
should be filled up to three quarter should be different times to collect different types of separate location that will reinforce the importance of
wastes to avoid mis separating the waste in the point of generation.

Step 7- Bag closing and labelling Step 9-Sharps containers

All the bags/containers caring wastes should be Step 8-Temporary storage The container that has sharps should be labelled Sharps in the
sealed properly with detail labelling that will Before the wastes are collected for treatment it is relevant language that will help the staffs to understand what it
identify who are the responsible for producing the stored in a temporary place after collection of wastes contains. After it is filled the container should be sent for
amount and where it is going from different departments in the hospital. disposal with infectious wastes.

Step 12-Central storage points Step11-Internal transport Step 10-Trollyeys and bag holders
In the central storage point places should be marked While the different types of wastes are transferred to All the trolleys, bags and containers holders should be
where the black and yellow waste bags/container should the temporary storage areas it should not be carried either black or yellow. If that is not possible in some
be placed before it is went off –site. In the summer it together as there could be a chance of waste mixture cases then clear signs should be in placed to identify the
should be collected every 24 hours and in winter it is 48 in the same trolley. wastes properly.
hours

Step 13-Highly infectious wastes Step 14-Other Hazardous health-care wastes Step 15-Traning
Highly infectious should be first autoclaved after Other five types of hazardous waste handling are not The waste management system in a hospital should be
that it should be put into the yellow bags. covered by these procedures. clearly set out in a waste management plan. All the staffs
should be well award if necessary new members and staffs
should be trained for better outcomes.
 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011) 39

(e) Tax the polluter- implement “polluter pays” However the waste management guidelines on
principle hospital should include the following
recommendations for effective hospital waste
Along with these we also develop a in-house
management system: (a) More emphasis should be on
management plan for all healthcare establishments.
waste segregation at the source by introducing
The hospital, clinic, diagnostic centres and other
different colour code bags or containers that will help
healthcare institutions must have a separate
proper channelling of the hospital waste. (b) Hospital
department for managing the medical waste. This
Authority should provide proper disposal site for the
department will be responsible for arranging create
time being before any system developed (c) The City
awareness, training, do regular monitoring and
Corporation should take initiatives for regional waste
evaluate the system for updates. An attempt has been
treatment plan by providing places for medical waste
made in by identifying activities in figure 8 to
dumping (d) The government needs to upgrade the
develop a step by step approach for medical waste
waste disposal system and consider the international
management department.
principles as their guideline for better practice in
Currently increased interest on improper disposal of hospital waste management. (e) Strict law policy
medical waste has led to a movement to regulate the should be made and future plans of waste
medical waste more scientifically. We should try to management should emphasis on waste tracking
minimize and recycle some of medical wastes before system. (f) Implement polluter pays principle where
final disposal, if it is not infected or contaminated. hospital should be pay for their wastes. (g) More
Similar plan like PRISM could be used in medical private companies should be encouraged to come
waste treatment until which will be cheaper and forward and take initiative to manage the medical
effective. Emission of toxic substances from any wastes (h) The authority should have proper system
healthcare establishment should be closely monitored for recycling of hospital waste and removal, (i) Build
to reduce potential risks to humans and the strong communication across the Ministry of family
surrounding environment. Achieving a good standard Welfare, Ministry of Environment, City Corporation
of cleanliness in health-care institutions is an Local authorities and NGOs should communicate for
important component in controlling the better waste management.
infection.However at present there are practically no
CONCLUSION
environmentally friendly, low-cost options for safe
disposal of infectious hospital wastes. More research Hospitals in Bangladesh pose significant threat to
needs to be carried on hospital waste for better health and environment on account of inadequate
management of waste that will have less impact on waste management need to raise awareness and
the health of the human beings who are at risk. provide educational training on medical waste
management. Proper waste management policy is
RECOMMENDATION ON MEDICAL WASTE
required to ensure health and environmental safety
MANAGEMENT
and it is recommended that simple changes in policy
Firstly we need to develop a national policy for safe and support from government and private sectors
health-care waste management Along with the policy would bring innovative changes in healthcare waste
we also need to keep in mind that in a country like management. However the healthcare waste
Bangladesh where the waste handlers are illiterate, management guideline, planning and policy should
the hospital/clinical waste procedure should be very be under the shadow of legislation, emphasis should
simple. The national policies should include the be given in the development of educational training
following issue: (a) The government should be wade programme, record keeping, monitoring, review of
accountable. (b) Development of an enforcement existing situation and there should be collaboration
mechanism (c) Setting of practical targets or between inter ministerial, hospital authorities, and
objectives over a specified time period (d) active participation from the community.
Establishment of a national and regional
Indeed a good number of organisations are working
infrastructure for health-care waste disposal (e)
on Health Care Waste Management System. As such
Support of regional and municipal authorities in
the situation has improved considerably in some part
implementation (f) Integration of waste minimization
of Dhaka only but we are far frome appreciation for
into national purchasing policies (g) Routine
the responsibility of medical doctors and
monitoring of impact through process indicators
management with respect to hospital waste. Now the
(number of health-care establishments with safe
task is for government to formulate appropriate
waste management systems) and outcome indicators
policy with a manual that needs to be followed by all
(e.g. number of accidents involving health- care
the hospitals, clinics and diagnostic centres in
waste).
Bangladesh. Then, through training and guidance
supported by DGHS and private (training) NGOs, the
 40 Tarannum Dana / OIDA International Journal of Sustainable Development 02:09 (2011)

application of guidelines and procedures associated http://www.int/water_sanitation_health/Environ

with effective enactment of the law through DoE ment_sanit/Healtcare_waste/decision.htm
needs to be promoted. At the same time government [10] DGHS Manual for Hospital Waste Management,
and the private sector should create a central facilities 2001.
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waste, through landfill, incineration or otherwise like Review, In Ahmed., ed. Bangladesh
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