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International Journal of E
nvironmental Protection and Policy
2017; 5(2): 26-31
http://www.sciencepublishinggroup.com/j/ijepp
doi: 10.11648/j.ijepp.20170502.12
ISSN: 2330-7528 (Print); ISSN: 2330-7536 (Online)
Research/Technical Note
Study of Clinical Waste Management at Rajshahi Medical
College Hospital (RMCH) in Bangladesh
Md. Shamim Al Razib, Nazmul Hasan, Supriya Mondal
Department of Civil Engineering, Rajshahi University of Engineering & Technology, Rajshahi, Bangladesh
Email address:
shamimrazib.ruet@gmail.com (Md. S. A. Razib), nazmulhasan.ruet@gmail.com (N. Hasan), supriyace06@gmail.com (S. Mondal)
To cite this article:
Md. Shamim Al Razib, Nazmul Hasan, Supriya Mondal. Study of Clinical Waste Management at Rajshahi Medical College Hospital (RMCH)
in Bangladesh. International Journal of Environmental Protection and Policy. Vol. 5, No. 2, 2017, pp. 26-31.
doi: 10.11648/j.ijepp.20170502.12
Received: April 2, 2017; Accepted: April 12, 2017; Published: May 5, 2017
Abstract: The management of clinical waste is of great importance due to its infectious and hazardous nature that can cause
risks on environment and public health. The study is conducted to evaluate clinical waste management practices and to determine
the amount of waste generated at Rajshahi Medical College Hospital (RMCH) in Bangladesh. A survey is driven to collect
information about the practices related to waste segregation, collection procedures, type of temporary storage containers,
on-site transport and primary dumping point, treatment of wastes, off-site transport, and final disposal options. This study
indicates that the quantity of medical waste generated by RMCH is 156 kg/day. Almost half of the waste was similar to
domestic waste and 20% of the waste is considered to be hazardous waste. The survey result shows that segregation of all
wastes is not conducted according to consistent rules and standards where some quantity of medical waste is disposed of with
domestic wastes. The most frequently used treatment method for solid medical waste is incineration which is not done
regularly at RMCH and the position of the incinerator is not acceptable. Clinical wastes pose a significant impact on health and
environment. From this study it can be said that there is an urgent need for raising awareness and education on medical waste
issues. For further study, it is needed to collect more information on impacts, disposal and management to draw a clear
conclusion. Need to collect information and examples from developed country or the country which has sound medical waste
management system.
Keywords: Solid Waste Management, Segregation, Incineration, Rajshahi Medical College Hospital (RMCH),
Hazardous Waste, Domestic Waste, Clinical Waste
1. Introduction
The clinical waste management study covers the critical
aspects in the process of clinical waste generation, separation,
collection, transportation, storage, treatment and final disposal.
Improper management of clinical waste can create many
problems especially threats to the health, safety and
environment [1]. No matter how small the quantity of waste
(i.e. clinical waste) can be extremely dangerous to the health
of the general public and the environment [2]. According to
Akter (1997), 82.24 percent respondents described medical
wastes as general waste, it is clear that most people are simply
unaware of and unclear about what constitutes medical wastes
[3]. Clinical waste is not attracted the same level of attention
as other types of wastes, particularly in developing countries,
despite the fact that medical waste is labeled as hazardous
because it poses serious and direct threat to human health [4].
In Bangladesh, as in many other developing countries, no
proper and efficient rule has been compiled as yet and also
there is no useful information about clinical waste
management.
The report on “Clean Dhaka Master Plan” conducted by the
Japan International Cooperation Agency (JICA) explained
about the management pattern of solid waste in Dhaka City [5].
The Local Initiative Facility for the Urban Environment (LIFE)
carried out a project on “In-house Hospital waste management”
in aiming the waste management of 11 clinics in Dhaka City
with the financial assistance of the UNDP released by the
International Journal of Environmental Protection and Policy 2017; 5(2): 26-31 27
global sources [6]. The project started on 2002 and finished by
2003. In 2004, Patil and Pokhrel described the biomedical
solid waste management in an Indian hospital. They quantify
the amount of non-infectious and infectious waste (ratio 5:1)
generated in different wards/sections [7].
In 1999, Mato and Kaseva in their paper on “Critical review
of industrial and medical waste practices in Dar es Salaam
City” focused that there is a serious inadequacy in handling
medical solid wastes in Dar es Salaam of Tanzania and
improper waste deposition is increasingly becoming a
potential public health risk and an environmental burden in
Tanzania [8].
The use of landfills remains the most popular method for
disposing clinical waste in both developed and developing
countries. Diaz et al (2005) makes a distinction between
controlled landfills and sanitary landfills [9]. In the absence of
controlled and sanitary landfills, medical establishments,
according to Pruss et al (1999) can prepare a small burial pit in
a restricted area purposely for disposing only infectious
clinical waste [10]. The depth of such a pit according to him
should reach 2 m deep and the bottom should at least be 1.5 m
away from ground water level.
In RMCH, it is observed that the solid hospital wastes are
being disposed temporarily in the recycle bin. The recycle bins
are kept in front of each ward. There is a waste collector for
each ward who collects waste and transfers to the primary
dumping station inside the Hospital area. There are 57 ward &
4 other (ICU, Postoperative, Dialaisis-room,
Engeogram-room) wards from where solid waste are
transported to the primary dumping station. There are different
kinds of solid hospital waste. It was not possible to
disintegrate all types of waste as it takes so much time to
disintegrate & some clinical waste (blood, needle) are very
hazardous so it was not possible to weight those. We
differentiated Solid Hospital waste into some basic types-
Sharps, Pathological waste, Pharmaceutical waste and others
waste. Sharps can be further divided into two types- Syringe
and Needle. Pathological waste can be divided into four types-
Cotton, blood bag, hand gloves and bandage, pharmaceutical
waste can be divided into three types- glass bottle, drug shell
and saline. This pathological waste is very dangerous for
human [11].
The transportation systems of wastes are varied from
country to country. In case of Libya, on-site clinical waste
transportation as recounted by Sawalem [12], is done via
uncovered trolleys while in Nigeria, Coker et al (2009)
reported that clinical waste in health care facilities is
transported on shoulders or with bare hands [13]. In case of
RMCH, City Corporation waste collection vehicle comes at
the primary station at a certain times in a day and transported
to the final dumping station. Before dumping, in temporary
storage no action is taken against microbial putrefaction and
growth but it really important.
Our primary aim is to take weight of the solid waste
generated from the Hospital for each ward which is
transported to the primary dumping station. Then by knowing
the number of bed present in each ward then we can determine
the amount of waste generated per bed. By analyzing the data
we can also determine the peak waste producing day in a week.
As most of the waste collection bins are not large enough to
carry the waste and the number of waste collection bins are
also very few, the data collected will help in further waste
management work.
The objectives of this research are to collect information on
the collection, treatment, handling, hauling, and disposal of
medical wastes and quantify hospital wastes production in
Rajshahi Medical College Hospital. Similarly determine the
composition of generated clinical wastes in Rajshahi Medical
College Hospital and also determine the level of knowledge
and awareness of individuals involved in the medical waste
management.
2. Methodology
2.1. Research Design
This study is mainly based on data collection. The relevant
data for this study were mainly collected from the published
and unpublished sources. The data were analyzed to address
the central issues of hospital waste management with relation
to the generation of wastes in different sources. In order to
fulfill the aims and objectives, the project tasks were
structured as data collection and data analysis. Sekaran (2009)
defined a research design as a master plan specifying the
methods and procedures which are used to guide and conduct
a research [14]. It is a strategic plan for a research project
including the methods of data collection and analysis to be
employed and showing how the research strategy addresses
specific aims and objectives of the study [15].
In this study we have just measured the amount of the waste
is being generated in each ward. It was done by following a
procedure. We have divided the hospital waste into some basic
category. Then the waste transferred from ward to the primary
disposal point is measured according to the category. After
that by analyzing the data the waste production per bed is
measured. It is also measured that what types of waste
produced and quantity.
2.2. About Rajshahi Medical College Hospital (RMCH)
The public hospital RMCH is located in the northern part of
Bangladesh. The capacity of the Rajshahi Medical College
Hospital is 2148 beds. The total no of doctors, nurses and
cleaners are 169, 349, and 137 respectively. The average no. of
inpatients and outpatients per day are 200-220 and 200-210
respectively. Total amount of waste generated is 200-350 kg/day
of which amount of hazardous waste is 50-60 kg/day. The toxic
and hazardous waste of RMCH is incinerated in its own
incinerator. The RMCH is directly connected with Rajshahi City
Corporation (RCC) in regard to Solid waste disposal.
2.3. Segregation and Measurement of Hospital Waste
By asking question to the waste collector and during
visiting each ward we have seen that segregation of waste is
done before disposal. Although segregated waste is not
28 Md. Shamim Al Razib et al.: Study of Clinical Waste Management at Rajshahi Medical
College Hospital (RMCH) in Bangladesh
recycled, they use the separate bags for different types of
waste and they use the separated plastic bins for infectious,
sharp waste and general waste. But in general there is no
systematic segregation of waste before disposal.
There are several types of solid Hospital waste. It is not
possible to segregate all types of waste as it takes so much
time to segregate & some clinical waste (blood, needle) are
very hazardous so it is not possible to weight those. We have
taken fifteen types of solid hospital waste in consideration
further we differentiate Solid Hospital waste into some basic
types- Sharps, Pathological waste, Pharmaceutical waste and
others waste. Sharps can be further divided into two types-
Syringe and Needle. Pathological waste can be divided into
four types- Cotton, blood bag, hand gloves and bandage,
pharmaceutical waste can be divided into three types- glass
bottle, drug shell and saline.
After segregation process the waste is taken into a box or
sometimes in polythene to measure the weight of the segregated
waste. The weight is taken in kg up to two decimal. The weight of
the box and the poly bag is taken for the accurate measurement of
the weight. As the weight meter is an electric machine so first it is
checked that if the machine is charged properly. If the machine is
charged properly then the machine has been calibrated. In weight
measuring machine weight is taken shown in figure 1 (a), (b) and
(c). Weight meter have shown the exact reading of the weight of
waste in the digital screen.
(a) Glass bottle
(b) Pharmaceutical waste
(c) Drag box or paper box
Figure 1. (a) (b) and (c) Showing weight measurement of the solid waste in
electric.
2.4. Color Coding System of Sample Hospital
For effective waste separation, in addition to identifying its
source and persons responsible, color coding system is needed.
Normally wastes from all hospitals are collected in plastic
containers in hospitals. In Rajshahli Medical College and
Hospital the color coding container exists but it’s not used
properly. Generally three colors are used. Green or Black is
used for general waste, yellow color is used for infectious
waste and red color is used for sharp wastes which are shown
in figure 2 below. The color coded container is used according
to the international rules. But in RMCH the color code is used
according to type of the waste.
Figure 2. Different types of container for different types of waste.
International Journal of Environmental Protection and Policy 2017; 5(2): 26-31 29
Figure 3. Incinerator in RMCH.
2.5. Waste Treatment and Disposal Method
There are many treatment methods for hospital waste as per
WHO guideline. Hospital wastes include general waste and
hazardous waste from health care facilities. The hazardous
wastes include blood & sharps are separated from the hospital
waste. The hazardous waste is incinerated inside the hospital
in an incinerator two times in a week shown in figure 3 above.
The incinerated residue is then dumped into the primary waste
disposal point.
In Rajshahi Medical College the waste is dumped in the
temporary waste storage bins inside the hospital compound.
The primary waste collection point is inside the hospital. The
Hospital use manual transportation to temporary storage bin
by workers. There are many disposal methods for hospital
waste. This includes open dumping by Rajshahi City
Corporation. Recyclable materials are collected by workers
and cleaners, but they do not separate this waste for sale. It is
found that recyclable materials are syringes, plastic bags and
bottles, urine bags, plastics accessories, glass bottles, glass
accessories, plastic polythene, metal, rubber and paper.
3. Results and Discussion
3.1. Results
In this study, data is analyzed in three different formats.
First of all data is analyzed for waste generation in each day of
a week in kg. Then percentage of waste generated according to
the characteristics of waste is analyzed. Last of all data is
analyzed for the daily waste generation rate per bed per day
from which we can understand the waste generation for each
bed. Everyday data is collected for each ward. After that total
waste generation is measured by taking sum of all wards waste
generation. Then average is taken to measure the average daily
waste generation rate. The Average waste production is:
156.85 kg/ day.
Table 1. Daily and Average waste generation per day.
Day Date Total Waste Generation per day
Sunday 25/10/15 372.69 Kg
Monday 26/10/15 185.101 Kg
Tuesday 27/10/15 187.551 Kg
Wednesday 28/10/15 198.464 Kg
Thursday 29/10/15 155.101 Kg
Total Waste Generation in a week 1098.907 Kg
Data was taken for a week. The figure 4 below shows the
waste generation per day. The amount of waste generated
mainly depends on the total number of patient. Generally
Sunday is the peak waste generation day in a week as Friday
and Saturday is the govt. holiday.
Figure 4. Waste generation at different day in a week.
Figure 5. Average generation of waste in percentage.
30 Md. Shamim Al Razib et al.: Study of Clinical Waste Management at Rajshahi Medical
College Hospital (RMCH) in Bangladesh
After the collection of data according to the characteristics,
it is just analyzed to get the result in percentage. The result is
shown in the above pie chart (Figure 5). Production of the
percentages of waste depends on the type of the hospital.
As RMCH is a public hospital the number of patient admits
in hospital is very high. If the number of patient increases then
the amount of waste generation also increases. Figure 6 shows
waste generation for each bed.Though it depends on the types
of ward and the nature of the patient.
Figure 6. Waste generation per bed per day.
3.2. Discussion
From the field investigation, it is observed that Rajshahi
Medical college Hospital is systematic for color coding and
segregation. Though the hospital waste management authority
tries to obey WHO standards, there is some deflection from
the standard guideline. No recycling is done in RMCH. The
Hospital staffs of Rajshahi Medical College Hospital have less
awareness about the disposing method. Some of the waste
collectors wear gloves but most of them do not wear the
gloves. We have not seen any waste collector who wore safety
mask, boot and safety clothes.
The waste collectors from all hospital should carry the
waste with trolley but sometimes they carry and transport the
waste in their own hand. It has also seen that some waste
collector carrying waste in the bucket in lieu of color coded
container.
The hospital staffs need more training and proper
knowledge about the clinical waste and its management.
Therefore, the efficient hospital waste management practice is
essentially needed for Rajshahi Medical College Hospital
(RMCH). It is a joint venture that the authorized person from
RMCH and solid waste management organization should try
for possible waste reduction way from the hospitals. The
hospital should follow the WHO guideline in the case of color
coding. Temporary storage is kept separate for the general
waste and hazardous waste.
Rajshahi City Corporation manages treatment and disposal
of hospital waste in Rajshahi City. They use incineration
method for treatment. They cannot follow WHO guideline
properly. General waste from hospital is sent to the open
dumping site. Therefore, the Rajshahi Medical College
Hospital should try to improve their waste management
practice.
4. Conclusion
Medical waste poses a great impact on human health and
our environment. There is lack of proper technical support
from the government in this sector and needs more investment.
At a regular interval workshop might be arranged to increase
awareness among the waste managing authority of the
Hospital. It has been also seen from the study that there is a
lack of man power, technical knowledge, and investment in
the hospital. So it may say that, Proper waste management
strategy is needed to ensure health and environmental safety.
The storage, collection, transportation, and disposal
systems are improper. So authority should take special
concern about this. And also Consideration needs to be given
to the generation and minimization, source separation and
segregation, identification and labeling, handling and storage,
safe transportation and treatment.
Infectious waste, excluding sharps should be collected in no
more than one day a week, unless the waste is refrigerated.
The sharps receptacles are exchanged at regular intervals of
three months. Arrangements should be made to routinely
transport waste from ward level to a storage area pending
collection by a waste contractor.
The problems confronting the hospitals include lack of
instructions on the aspects of clinical waste segregation and
practices by nurses and intermingling of clinical waste with
general waste. It is no doubt that problem in improper
segregation of clinical waste and general waste is a common
problem in clinical waste management worldwide. However,
it is still important to keep the segregation process according
to the standard and guidelines as to ensure the safety and
health of the people and environment.
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