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, Bangladesh

INTRODUCTIONWhat 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 Used chemicals and outdated pharmaceuticals pose a health and environmental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 BANGLADESHAccording 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 planningInternational 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

Recycling of selected

materials Waste Segregation

Return outdated drugs or chemicals

to the supplier

General waste joins the municipal

waste stream Treatment & Disposal of health-care waste

Treatment Incineration, on-site or off-site-open-air burning, Chemical disinfection, Autoclaving of highly infectious

waste, Encapsulation Disinfection of stools from cholera patients & of other infectious Bodily fluids

Assign Responsibilities

Classify & Assess Waste Generation

Identify Reuse options

Adequately treat & dispose of wastewater

Train personnel & waste workers

Ensure safe

storage

Ensure worker’s

safety Improve stock management of

chemicals & pharmaceuticals

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