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Pattern of medical waste management: Existing scenario in Dhaka City, Bangladesh

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Medical waste is infectious and hazardous. It poses serious threats to environmental health and requires specific treatment and management prior to its final disposal. The problem is growing with an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh. However, research on this critical issue has been very limited, and there is a serious dearth of information for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage, transportation and disposal) along with the types and amount of wastes generated by Health Care Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant information. The methodology for this paper includes empirical field observation and field-level data collection through inventory, questionnaire survey and formal and informal interviews. A structured questionnaire was designed to collect information addressing the generation of different medical wastes according to amount and sources from different HCE. A number of in-depth interviews were arranged to enhance our understanding of previous and existing management practice of medical wastes. A number of specific questions were asked of nurses, hospital managers, doctors, and cleaners to elicit their knowledge. The collected data with the questionnaire survey were analysed, mainly with simple descriptive statistics; while the qualitative mode of analysis is mainly in narrative form. The paper shows that the surveyed HCE generate a total of 5,562 kg/day of wastes, of which about 77.4 per cent are non-hazardous and about 22.6 per cent are hazardous. The average waste generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The study reveals that there is no proper, systematic management of medical waste except in a few private HCE that segregate their infectious wastes. Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes for resale or reuse. The paper reveals that lack of awareness, appropriate policy and laws, and willingness are responsible for the improper management of medical waste in Dhaka City. The paper also shows that a newly designed medical waste management system currently serves a limited number of HCE. New facilities should be established for the complete management of medical waste in Dhaka City.
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BioMed Central
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BMC Public Health
Open Access
Research article
Pattern of medical waste management: existing scenario in Dhaka
City, Bangladesh
M Manzurul Hassan*
1
, Shafiul Azam Ahmed
2
, K Anisur Rahman
3
and
Tarit Kanti Biswas
3
Address:
1
Department of Geography and Environment, Jahangirnagar University, Savar, Dhaka, Bangladesh,
2
Water and Sanitation Programme,
World Bank, Agargaon, Dhaka, Bangladesh and
3
Prism Bangladesh, House: 49, Road: 4/A, Dhanmondi, Dhaka, Bangladesh
Email: M Manzurul Hassan* - manzurulh@yahoo.com; Shafiul Azam Ahmed - saahmed22@gmail.com; K
Anisur Rahman - prismbd_env@yahoo.com; Tarit Kanti Biswas - taritbd2002@yahoo.com
* Corresponding author
Abstract
Background: Medical waste is infectious and hazardous. It poses serious threats to environmental health
and requires specific treatment and management prior to its final disposal. The problem is growing with
an ever-increasing number of hospitals, clinics, and diagnostic laboratories in Dhaka City, Bangladesh.
However, research on this critical issue has been very limited, and there is a serious dearth of information
for planning. This paper seeks to document the handling practice of waste (e.g. collection, storage,
transportation and disposal) along with the types and amount of wastes generated by Health Care
Establishments (HCE). A total of 60 out of the existing 68 HCE in the study areas provided us with relevant
information.
Methods: The methodology for this paper includes empirical field observation and field-level data
collection through inventory, questionnaire survey and formal and informal interviews. A structured
questionnaire was designed to collect information addressing the generation of different medical wastes
according to amount and sources from different HCE. A number of in-depth interviews were arranged to
enhance our understanding of previous and existing management practice of medical wastes. A number of
specific questions were asked of nurses, hospital managers, doctors, and cleaners to elicit their knowledge.
The collected data with the questionnaire survey were analysed, mainly with simple descriptive statistics;
while the qualitative mode of analysis is mainly in narrative form.
Results: The paper shows that the surveyed HCE generate a total of 5,562 kg/day of wastes, of which
about 77.4 per cent are non-hazardous and about 22.6 per cent are hazardous. The average waste
generation rate for the surveyed HCE is 1.9 kg/bed/day or 0.5 kg/patient/day. The study reveals that there
is no proper, systematic management of medical waste except in a few private HCE that segregate their
infectious wastes. Some cleaners were found to salvage used sharps, saline bags, blood bags and test tubes
for resale or reuse.
Conclusion: The paper reveals that lack of awareness, appropriate policy and laws, and willingness are
responsible for the improper management of medical waste in Dhaka City. The paper also shows that a
newly designed medical waste management system currently serves a limited number of HCE. New
facilities should be established for the complete management of medical waste in Dhaka City.
Published: 26 January 2008
BMC Public Health 2008, 8:36 doi:10.1186/1471-2458-8-36
Received: 3 November 2006
Accepted: 26 January 2008
This article is available from: http://www.biomedcentral.com/1471-2458/8/36
© 2008 Hassan et al; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0
),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
BMC Public Health 2008, 8:36 http://www.biomedcentral.com/1471-2458/8/36
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Background
Medical waste, due to its content of hazardous substances,
poses serious threats to environmental health [1,2]. The
hazardous substances include pathological and infectious
material, sharps, and chemical wastes [3-6]. In hospitals,
different kinds of therapeutic procedures (i.e. cobalt ther-
apy, chemotherapy, dialysis, surgery, delivery, resection of
gangrenous organs, autopsy, biopsy, para clinical test,
injections etc.) are carried out and result in the production
of infectious wastes, sharp objects, radioactive wastes and
chemical materials [7]. Medical waste may carry germs of
diseases such as hepatitis B and AIDS. In developing coun-
tries, medical waste has not received much attention and
it is disposed of together with domestic waste [8,9].
Improper medical waste management is alarming in
Bangladesh and it poses a serious threat to public health.
Medical waste contains highly toxic metals, toxic chemi-
cals, pathogenic viruses and bacteria [10-12], which can
lead to pathological dysfunction of the human body
[13,14]. Medical waste presents a high risk to doctors,
nurses, technicians, sweepers, hospital visitors and
patients due to arbitrary management [15,16]. It is a com-
mon observation in Dhaka City that poor scavengers,
women and children collect some of the medical wastes
(e.g. syringe-needles, saline bags, blood bags etc.) for
reselling despite the deadly health risks. It has long been
known that the re-use of syringes can cause the spread of
infections such as AIDS and hepatitis [17]. The collection
of disposable medical items (particularly syringes), its re-
sale and potential re-use without sterilization could cause
a serious disease burden [18].
The safe disposal and subsequent destruction of medical
waste is a key step in the reduction of illness or injury
through contact with this potentially hazardous material,
and in the prevention of environmental contamination
[19]. The transmission of blood-borne viruses and respi-
ratory, enteric and soft tissue infections through improper
medical waste disposal is not well described [7]. The man-
agement of medical waste therefore, has been of major
concern due to potentially high risks to human health and
the environment [20,21].
The growing number of hospitals, clinics, and diagnostic
laboratories in Dhaka City exerts a tremendous impact on
public health and environment. All of the hospitals, clin-
ics, and diagnostic laboratories are considered here as the
HCE. Some 600 HCE in Dhaka city generate about 200
tons of waste a day [22]. Like ordinary household waste,
medical wastes are generally dumped into DCC bins. It is
reported that even body parts are dumped on the streets
by the HCE. The liquid and solid wastes containing haz-
ardous materials are simply dumped into the nearest
drain or garbage heap respectively.
Proper management of medical waste is crucial to mini-
mise health risks. The improvement of present waste man-
agement practices for HCE in Bangladesh will have a
significant long-term impact on minimising the spread of
infectious diseases. Medical waste requires specialized
treatment and management from its source to final dis-
posal. Simply disposing of it into dustbins, drains, and
canals or finally dumping it to the outskirts of the City
poses a serious public health hazard. Thus, there is a need
to initiate a concentrated effort to improve the medical
waste management to reduce the negative impact of waste
on: (a) environment; (b) public health; and (c) safety at
health care facilities.
There are different types of medical waste management
systems in different countries [3,4,9,23-26]. Although,
medical waste disposal options are not completely risk-
free, the risks can be minimized with care [27]. Improper
disposal of medical waste may include damage to humans
by sharp instruments, diseases transmitted to humans by
infectious agents, and contamination of the environment
by toxic and hazardous chemicals [28-30]. Therefore,
proper management of medical waste is a subject of major
concerns for a healthy environment. In Bangladesh, med-
ical waste management systems to reduce the environ-
mental and public health risk are grossly inadequate
[31,32].
Medical wastes account for a very small fraction, about
one percent of the total solid wastes generated in Bangla-
desh [31]. However, when this tiny amount is not han-
dled properly, it gets mixed with domestic solid waste,
and the whole waste stream becomes potentially hazard-
ous. Until recently, there was no system for proper medi-
cal waste management in Bangladesh to protect
environmental health hazards. It was generally disposed
of in the same way as ordinary domestic waste. But, very
recently, government is trying to develop a system to han-
dle medical waste properly. This paper seeks to document
an inventory of different HCE in Dhaka City and to quan-
tify the amount of wastes generated by each HCE. In addi-
tion, the paper presents the current waste handling
practices in terms of storage, collection, transportation
and disposal within and outside hospital premises.
Methods
An extensive questionnaire survey provided breadth of
coverage, while in-depth interviews with nurses and dif-
ferent respondents in HCE allowed a greater understand-
ing of the waste management system within each surveyed
hospital, clinic, and diagnostic centre. The collected data
for this study were analysed to address the central issues
of hospital waste management in relation to the genera-
tion of wastes from different sources.
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Study sites
Two municipal administrative wards (Wards 49 and 56)
of Dhaka City were selected for this study. Dhanmondi
(Ward 49), once a quiet residential area, was zoned for
commercial establishments by the RAJUK (Rajdhani
Unnayan Katripakkha, Capital Development Authority) in
1972. As a result, the number of hospitals, clinics and
diagnostic centres in Dhanmondi has been increasing
steadily. These HCE indiscriminately dump medical waste
around their premises. Many poor children and adults sal-
vage these items. Dhanmondi is a densely populated area
and the number of HCE in Dhanmondi is the highest of
all the administrative wards in Dhaka City.
Dhaka Medical College Hospital (DMCH), located in
Ward 56, is the largest hospital in Bangladesh and creates
a lot of waste. Therefore, Dhanmondi and the DMCH
were selected to investigate the situation of medical waste
generation and the existing management scenario (Figure
1). High population density in the study sites assures that
a large number of people are exposed to toxic level of
medical waste. In addition, school children are consid-
ered to be most vulnerable because the study sites are
mainly located close to schools.
Data
No statistically rigorous sampling procedure could be fol-
lowed for this study. Those HCE who were willing to pro-
vide us information were selected for this study. It was not
easy to collect relevant medical waste data from HCE since
a number of HCE did not follow the existing rules and reg-
ulations to run them properly. This is why some HCE
authorities were not interested to give permission in col-
lecting data from their own institutions. A total of 60 out
of existing 68 HCE in the study site gave us permission to
collect waste data. Accordingly, we collected our data
from these 60 HCE. Before entering a HCE, we arranged a
number of formal meetings with the concerned authority
of each HCE to explain the purpose of the study and seek
their cooperation. After receiving consent, we started our
fieldwork. A number of face-to-face formal and informal
approaches were adopted in order to gather data.
In collecting our data, questionnaire surveys and in-depth
interviews were adopted. Apart from this, the dialectic
approach was used to confirm the credibility of stories
and examine the 'cross-case themes' [33] that we gathered
from in-depth interviews. The term 'dialectic' is a set of
questions for trying to understand the empirical reality
rather than a set of pre-designed answers [34]. This
approach presents a way of thinking about intercultural
communication that allows for a very rich understanding
[35].
A questionnaire was designed following the objectives of
this study. A total of 139 questionnaires (61 from DMCH,
The study area and location of different HCE and DCC bins in the study sitesFigure 1
The study area and location of different HCE and DCC bins in the study sites. Almost all the HCE dispose their generated
waste into the DCC bins located close to them.
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59 from Ward 49, and 19 from BMCH) were surveyed.
The questionnaire mainly addressed the issues of: (a)
types of generated medical wastes; (b) sources of medical
wastes; (c) amount of generated wastes; and (d) existing
waste management practices. The occupation segmenta-
tion with gender heterogeneity was considered to select
our respondents. Among the interviewees, 63 (45%) were
female and 76 (55%) were male respondents. All of the
female respondents were nurses, and the rest were doc-
tors, medical technicians, and cleaners. The average age of
the respondents was 39 years. Apart from the formal ques-
tionnaire survey, we had informal discussions with
patients for their understanding about existing medical
waste management.
The waste generation rates in the surveyed HCE were
obtained by actual measurements and through assess-
ment of the storage facilities emptying frequencies and the
degree of filling of the refuse receptacles. Different wastes
were used to store in different sizes of buckets in different
wards, and surgery departments. The weight of these
wastes was then measured in kilograms. The quantity of
waste in different categories was collected twice in a day
when the refuse receptacles emptied, but, in surgery
departments, nurses provided us additional information
regarding the quantity of generated wastes. We were very
careful about our data and nurses were helpful in gather-
ing the relevant information. The WHO guidelines were
followed to categorize the generated wastes from different
HCE in the study sites [7].
A number of in-depth interviews were arranged to get a
greater understanding of the existing management prac-
tice of medical wastes. In-depth interviewing is a highly
personal process where meanings are created through per-
sonal interaction [36-38]. A number of specific questions
were asked of nurses, hospital managers, doctors, and
cleaners for eliciting their understandings.
Analysis
The data collected by questionnaire survey were analysed
mainly with simple descriptive statistics; while the quali-
tative mode of analysis was mainly narrative. This method
was adopted for the qualitative abstraction and vivid pres-
entation of a new understanding of present medical waste
management practices. The spatial data – point features of
the HCE and DCC bins – were analysed with GIS for pres-
entation of the existing spatial pattern of HCE and their
final waste management in DCC bins. The distribution
pattern of different surveyed HCE and DCC bins is helpful
in describing the practice of medical waste dumping into
the DCC bins as part of the existing management system.
Results
Inventory of HCE
The relevant information collected for this study were
from general hospitals (30, 50.9%), private clinics (15,
25.4%), and diagnostic centres (14, 23.7%). Our field sur-
vey shows that the surveyed general hospitals, excluding
the BMCH, offer medical facilities for about 600 resident
patients and about 1,700 outpatients; the private clinics
provide medical treatments for about 300 resident
patients, and the diagnostic centres provide pathological
facilities for about 1,900 patients (Table 1). The BMCH is
the largest private hospital in Bangladesh and offers med-
ical treatments for about 300 resident patients and 750
outpatients per day. Moreover, DMCH providing medical
facilities for 1,700 resident patients and about 3,500 out-
patients per day with pathology, radiology and imaging,
microbiology, surgery, pharmacology and therapeutics,
gynaecology, etc. (Table 1).
Sources and Quantification
The amount of waste generated in hospitals depends
upon various factors such as the number of beds, types of
health services provided, economic, social and cultural
status of the patients and the general condition of the area
where the hospital is situated [3]. During our field survey,
it was observed that the surveyed HCE generated patho-
logical wastes, textiles stained with blood, cotton pads,
Table 1: Waste generation rates in surveyed hospitals
HCE Patients Total patients Waste generation rate
Beds Outpatients Kg/day Kg/bed/day Kg/patient/day
DMCH 1700 3500 5200 3274 1.93 0.63
BMCH 300 750 1050 673 2.24 0.64
Surveyed hospitals (Ward: 49)
- General Hospitals 591 1698 2289 943 1.60 0.41
- Private Clinics 293 - 293 380 1.30 -
- Diagnostic Centres - - 1867 292 - 0.16
All surveyed HCE 2884 5948 10699 5562 1.93 0.52
Source: Field survey, 2006
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used syringes, broken bottles and glasses, paper, cans and
other metals, vegetable/rubbish, and sharps (syringe-nee-
dles, surgical blades and blood lancets).
Together the surveyed HCE generate 5,562 kg/day of
wastes, of which 4,308 kg/day (77.4%) are general wastes
and 1,254 kg/day (22.6%) are hazardous wastes (Table
2). Our field survey reveals that the average waste genera-
tion rate for all the surveyed HCE on the basis of beds
available is 1.9 kg/bed/day (Table 1). The results compare
with the medical waste generation rates reported to be 2.7
kg/bed/day in hospitals of Tehran (Iran) [39]; between
0.84 and 5.8 kg/bed/day in hospitals in Dar-es-Salaam
(Tanzania) [23]; and between 4.5 and 9.1 kg/bed/day in
US hospitals, of which about 10 per cent is thought to be
infectious or disease-causing [6]. Kitchen wastes and other
non-hazardous wastes were found to be the highest com-
ponent in all the HCE in Dhaka and the quantity covers
more than three-quarters of the generated wastes, fol-
lowed by infectious wastes (14.1%), plastic wastes
(3.8%), liquid wastes (3.4%), and sharp items (1.2%)
(Table 2).
Discussion
Medical Waste Management: A Recent Past Scenario
Until recently (December 2005), there has been an
improper procedure of medical waste management in
Dhaka City. No HCE segregated their generated wastes,
except a very few. Medical wastes need to be segregated
separately according to their characteristics at the point of
generation [7]. In some HCE, all the infectious wastes
were found to be separated from the non-infectious waste
stream at the site of production, but during disposal in the
DCC dustbins the wastes were then mixed together. In all
of the HCE, pharmaceutical wastes and pressurized con-
tainers (e.g. inhalers, spray cans etc.) were disposed along
with the general waste. The intermingling of infectious
wastes with general waste in the HCE is a threat to envi-
ronmental health. Figure 2 shows the previous medical
waste management practices in Dhaka City.
Our field survey found that a very few private HCE used to
collect their in-house waste systematically. They used to
segregate their sharps and infectious wastes in separate
bins and send off them to the International Centre for
Diarrhoeal Disease and Research in Bangladesh (ICDDR,
B) for incineration at the rate of Tk.70.00 ($1.00) per kg
of waste. The two big hospitals in Dhaka City (DMCH and
BMCH) generally were found to be disposing of their
wastes into the DCC bins without segregating them. This
poses serious health risks to the personnel handling the
waste, to the scavengers at the dumpsite, and to the public
at large. The consequences of this practice extend to the
possibility of polluting both surface water and groundwa-
ter resources in the vicinity of dumpsite [4].
In the DMCH, generated wastes from gynaecology depart-
ments (e.g. sanitary napkins, liquid wastes, placenta, dis-
posable gloves, etc.) and operation theatres were found to
be collected in metal or plastic buckets for disposing into
DCC bins without segregation. Amputated body parts
(e.g. hands, legs, gall bladder, uterus, tumour, aborted
foetus, and many others) generated from operation thea-
tres were mainly disposed of in DCC bins by the sweepers
and cleaners. Some cleaners were found to be engaged in
mishandling the generated wastes within the HCE
premises and at the DCC bins. They salvage used sharps
(mainly the syringe-needles), saline bags, blood bags and
test tubes for resale or reuse.
Internal and central storage facilities are important to
store the collected waste for a certain period until safe dis-
posal. Some small HCE do not have any temporary stor-
age and they simply used to dispose the waste directly into
the nearest DCC bin. Every morning, the DCC collects
their bins from different roadsides and finally dumps at
Table 2: Amount of wastes with types generated in all surveyed HCE
Colour Type of wastes Amount (in kg)*
DMCH BMCH GH** PC** DC** Total
Black General waste (Kitchen waste, medicine box) 2587 (79.01) 563 (83.65) 729 (77.31) 286 (75.26) 143 (48.97) 4308 (77.45)
Yellow Infectious waste (Cotton bandage, amputated
body parts, placenta, blood & urine bags)
489 (14.94) 59 (10.57) 132 (14.00) 46 (12.10) 57 (19.52) 783 (14.08)
Green Plastic waste (Syringe without needle, saline
bags, gloves)
79 (2.41) 18 (3.22) 32 (3.39) 21 (5.53) 63 (21.57) 213 (3.83)
Red Sharp items (needle, blade, knife, Vial-ampoule) 36 (1.10) 6 (1.07) 12 (1.27) 9 (2.37) 6 (2.06) 69 (1.24)
Blue Liquid waste 83 (2.53) 27 (4.83) 38 (4.03) 18 (4.74) 23 (7.88) 189 (3.40)
Total: 3274 (100%) 673 (100%) 943 (100%) 380 (100%) 292 (100%) 5562 (100%)
Source: Field survey, 2006
* Figures in the parentheses indicate the per cent of each HCE category.
** GH: General Hospitals; PC: Private Clinics; and DC: Diagnostic Centres.
¤ For DC, Syringe (without needle) for injection and blood sampling was considered to be a hazardous element.
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different waste disposal sites located outside the city
boundary. Our field survey shows that all of the surveyed
HCE dispose of their domestic waste at the same site as the
municipal waste.
New Approach of Medical Waste Management
There are a number of guidelines for the management of
infectious waste materials from medical institutions
[11,40-44]. Medical facilities in different HCEs in Bangla-
desh are characterised by inadequate and inappropriate
refuse storage facilities, lack of refuse collection services,
improper disposal methods and inadequate and inappro-
priate protective gear for refuse handlers. In Bangladesh,
proper medical waste management is a new phenomenon
and Government of Bangladesh is trying to develop a new
and modern approach to deal with the medical waste
properly.
PRISM (Project in Agriculture, Rural Industry, Science and
Medicine) Bangladesh, a reputed national NGO in Bang-
ladesh, is now working for medical waste management in
association with the DCC. With financial and technical
support from Water and Sanitation Programme (WSP),
PRISM Bangladesh carried out a survey on the medical
waste management in Dhaka City. Subsequently, PRISM
Bangladesh with the financial support from Canadian
International Development Agency (CIDA) has recently
developed a disposal facility for low cost medical waste
treatment and management in Dhaka City. The DCC has
allocated one acre (0.405 hectare) of land in Matuail, a
dumpsite near the city limit for the final disposal of med-
ical waste. It is inadequate to handle all the medical
wastes of the city with the limited facilities of final dis-
posal. PRISM Bangladesh is managing the generated med-
ical waste in different forms (Figure 3).
In the new approach, PRISM Bangladesh is involved in
training relevant personnel of different HCE for increasing
awareness and proper in-house management of medical
wastes. A public awareness campaign for proper manage-
ment of medical waste would be effective in keeping up
the city environment safe. Awareness is essential to solve
this problem, particularly with regards to the reuse of
syringes and needles and other sharps contaminated with
human blood or body fluids. PRISM Bangladesh has
recently provided training for more than 3000 personnel
in 185 HCE.
PRISM Bangladesh has developed a system for collecting
segregated hazardous wastes (except radioactive wastes)
from each HCE through newly set up vehicles to carry this
waste for final dumping at their newly developed Matuail
Plant. It has introduced in-house storage of medical waste
in colour-coded bins. Segregation of waste at source into
suitable colour-coded bins is vital to a proper waste man-
agement. All of the HCE should now be using the Govern-
Previous waste management practice in Dhaka City, particularly before December 2005Figure 2
Previous waste management practice in Dhaka City, particularly before December 2005.
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ment of Bangladesh (GoB) approved colour-coded high-
density polyethylene bags for easy identification and seg-
regation of infectious and non-infectious medical wastes.
This minimises the actual volume of potentially infectious
medical waste and makes the disposal less costly and
more effective.
The colour codes recently introduced by the GoB should
be followed at all HCE for this purpose. Infectious waste
should be packaged: (a) to protect waste handlers and the
public from possible injury and disease that could result
from exposure to waste; and (b) to avoid attracting
rodents and vermin [9]. The integrity of packaging can be
preserved during handling, storage, transportation and
treatment. In all the surveyed HCE, sharp instruments are
generally stored in separate refuse receptacles. The colour-
coded waste segregation guide represents best practice and
ensures, at minimum, compliance with current regula-
tions. Some HCE in Dhaka City are paying a service charge
for the collection from their premises and final manage-
ment at the Matuail plant.
Reuse of syringes and needles is extremely harmful to
human health. There was no system and/or practice of
destroying needles from used syringes in the HCE in
Dhaka in near past. To protect resale and reuse of syringes,
both manual and electric needle destroyers have recently
been introduced to different HCE to cut needles from
syringes to protect against HIV and Hepatitis viruses. All
of the generated plastic items (i.e. syringes without nee-
dles and intravenous bags) and glass materials (i.e. vial,
ampoule, slide, broken glasses etc) are disinfected by
immersion in different strength chlorine chambers. Then
they are destroyed in a locally developed shredder
machine to prevent reuse. The disinfecting and shredded
plastic items are used for recycling. Moreover, a small
effluent treatment plant has recently been constructed to
treat the waste water generated in the plant. One heavy
duty autoclaving machine has recently been installed for
sterilizing cotton, gauge, bandage and such other contam-
inated materials. These sterilized materials are mixed up
with the general civic waste for disposing in DCC dump-
ing area. Organic infectious waste and sharp items are bur-
Existing waste management practice in some HCE Dhaka City (in-house waste segregation and final disposal) organised by PRISM BangladeshFigure 3
Existing waste management practice in some HCE Dhaka City (in-house waste segregation and final disposal) organised by
PRISM Bangladesh. This new system has been practised since December 2005.
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ied in the separate concrete burial pits at the newly
constructed plant.
All hazardous materials except plastic and polymer mate-
rials can be incinerated. An incinerator donated recently
by a Japanese organisation will be installed at the Matuail
plant. The use of an incinerator treats a large amount of
waste as well as reduces the volume of waste considerably.
Our field survey found that the DMCH had installed two
manually operated incinerators, but these incinerators
have been out of order for the last five years. Patil &
Pokhrel [9] are in favour of incineration; while Bakoglu et
al [45] and Karademir [46] assess health risk of Polychlo-
rinated Dibenzodioxin and Dibenzofuran (PCDD/F)
emissions from a medical waste incinerator in Turkey.
Maoa et al [47] also advocate against the incinerator
because of its mass emission of particulate matter (PM2.5/
PM10) and particle-bound polycyclic aromatic hydrocar-
bons (PAH), which is considered to be health risk.
Although there have been a number of criticisms of incin-
erators regarding their impact on the environment, this
incinerator has been shown to be an alternative technol-
ogy in destroying infectious medical wastes. If an inciner-
ator is operated properly (high and continuous
temperature, filtration of particulate emission, disulfura-
tion etc), it will not incur excessive risks and it can be
affordable for medical waste management.
Our field survey shows that all the HCE discharge their
liquid pharmaceutical and chemical waste into the gen-
eral sewers or drains in Dhaka City because none of them
have any proper liquid waste management facilities. Liq-
uid waste is mainly generated from patients' service units,
operation and surgical units, laboratories and other
health-care units. All the HCE surrounding the Dhan-
mondi Lake in Ward 49 dispose of their liquid waste into
this lake. Liquid waste generated from HCE is genotoxic
and is normally polluted with Biochemical Oxygen
Demand (BOD), Chemical Oxygen Demand (COD),
Total Suspended Solids (TSS), faecal coliform, and total
coliform content above tolerable limits [48]. The post
mortem department of the DMCH generates hazardous
wastes stained with blood, body fluids etc. Anatomical
waste is disposed through burial; liquid wastes are dis-
posed into general sewerage; and stained wastes are
burned manually.
Our field survey shows that a poor coordination between
two different ministerial agencies, Department of Envi-
ronment (DoE) (under the Ministry of Environment and
Forest, MoEF) and the DCC, has slowed down medical
waste management. The DCC is mainly responsible for
the operation of medical waste management, while the
DoE is the Authority for ensuring the environmental law
to be implemented. Thus, a good coordination between
the two agencies is emphasized. In addition, the DCC
should go for Public-Private Partnership (PPP), since the
DCC has a limited capacity for proper handling of medi-
cal waste in Dhaka City.
There is no national policy on medical waste management
in Bangladesh. For a proper and scientific management of
medical waste, government should give priority to formu-
late a policy. Moreover, the existing laws are generally out-
dated and characterised by low penalties and sometimes
no penalties at all for offenders. Thus, massive awareness
towards this issue and formulating new tougher laws
could be effective in protecting people and the environ-
ment from deadly medical waste. Recently a Law has been
proposed to handle medical waste properly, but it needs
to be adopted and enforced as soon as possible.
Conclusion
Disposal of medical wastes is a growing environmental
problem in Bangladesh. Until recently, the management
of medical wastes has received little attention despite their
potential environmental hazards and public health risks.
The paper has attempted to quantify different medical
wastes generated from different HCE in the study area.
The surveyed HCE generated about 77.4% of non-infec-
tious wastes and about 22.6% of infectious wastes. The
average waste generation rate for the surveyed HCE is 1.9
kg/bed/day. Our field data shows that almost all the HCE
do not segregate their generated wastes and they dispose
of their domestic waste at the same site as normal civic
waste.
The generation of medical waste in Dhaka has been
increasing in quantity and variety, due to the wide accept-
ance of single-use disposalable items. In the recent past,
medical waste was often mixed with household waste and
disposed of in municipal solid waste landfills. In recent
times, increased concerns over improper disposal of med-
ical waste have led to a movement to regulate the waste
more systematically. Efforts have to be made for minimi-
zation and recycling of some medical wastes prior to final
disposal, if not infected or contaminated. Incineration
could be used in medical waste treatment until another
common treatment method and steam sterilization is
available in near future. Therefore, toxic substances such
as dioxin emissions at medical waste incinerators should
be closely monitored to reduce potential risks to humans
and the surrounding environment [29].
Lack of awareness, appropriate policy and laws, and apa-
thy are responsible for improper management of medical
waste in Dhaka City. The process of collection, segrega-
tion and disposal of medical waste is not performed
according to recommended standards, and concerned
people are exposed to the danger of such wastes. Safe dis-
BMC Public Health 2008, 8:36 http://www.biomedcentral.com/1471-2458/8/36
Page 9 of 10
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posal of medical waste is essential and is handled in a very
professional way in many countries. The existing medical
waste management system currently serves a limited
number of HCE. New facilities should be established in
different parts of the city or the existing facility should be
expanded.
List of abbreviations
BMCH: Bangladesh Medical College Hospital; BOD, Bio-
chemical Oxygen Demand; CIDA, Canadian International
Development Agency; COD, Chemical Oxygen Demand;
DCC, Dhaka City Corporation; DMCH, Dhaka Medical
College Hospital; DoE, Department of Environment;
GoB, Government of Bangladesh; HCE, Health care Estab-
lishments; ICDDR, B International Centre for Diarrhoeal
Disease and Research in Bangladesh; ICU, Intensive Care
Units; MoEF, Ministry of Environment and Forest; OPD,
Out-patient-departments; OT, Operation Theatre; PAH,
Polycyclic Aromatic Hydrocarbons; PCDD/F, Polychlo-
rinated Dibenzodioxin and Dibenzofuran; PPP, Public-
Private Partnership; PRISM, Project in Agriculture, Rural
Industry, Science and Medicine; RAJUK, RAJdhani
Unnayan Kortipokkha (Capital Development Authority);
TSS, Total Suspended Solids; WSP, Water and Sanitation
Programme
Competing interests
The author(s) declare that they have no competing inter-
ests.
Authors' contributions
MMH was the principal investigator of this research. He
made substantial contributions to conception, design,
and drafting the manuscript with statistical analysis, map-
ping and interpretations. SAA made substantial contribu-
tions to conception, design, and drafting the manuscript
with data interpretation. KAR participated in designing of
the study & revising it critically for important intellectual
content. TKB made contributions to design the manu-
script with data collection and analysis. All authors read
and approved the final manuscript.
Acknowledgements
The authors would like to thank the WSP for providing support for the sur-
vey of the medical waste management in Dhaka City implemented by PRISM
Bangladesh. Special thanks go to Aktarun Naher, SM Harunoor Rashid Hira,
and SM Gubair bin Arafat for their cooperation in collecting the relevant
data. In addition, the authors would like to express their thanks to the ref-
erees for their review comments to improve the quality of the paper.
Finally, the senior author would like to express his gratitude to Professor
Peter J. Atkins, Department of Geography, Durham University, England for
his contribution to improve the manuscript.
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Pre-publication history
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... Overall, 94.1% (n = 399) of respondents accurately identi ed the appropriate color codes for medical waste (red, black, and yellow), with similar knowledge in private (94.6%, n = 226) and government facilities (93.5%, n = 173; p = 0.650). However, only 15.1% (n = 64) of respondents correctly identi ed green as the color code for general waste, with private workers showing slightly better knowledge (17.2%, n = 41) than government workers (12.4%, n = 23; p = 0.178). Most respondents (89.2%, n = 379) knew that medical waste should not be mixed with general waste, while 84.0% ...
... (p > 0.05). This nding is consistent with the studies of Hassan et al. [15], Debere et al. [16], and Dzekashu et al. [12], while it contrasts with the ndings of Mochungong et al. [17], who reported lower adherence to waste management practices. ...
Preprint
Full-text available
Background Healthcare facilities (HCF) are significant producers of healthcare waste (HCW), which includes hazardous materials such as sharps, pharmaceuticals, infectious substances, and chemical agents. Inadequate management of HCW presents serious risks to human health and the environment, especially in low- and middle-income countries, including Nigeria. Despite global guidelines for HCW management, challenges such as insufficient infrastructure, training, and adherence to regulations persist, particularly in regions like the Bwari Area Council, Abuja. This study evaluates healthcare workers' knowledge, attitudes, and practices (KAP) regarding healthcare waste management, compares practices between private and public healthcare facilities, and assesses adherence to national guidelines. Methods A cross-sectional study was conducted among 425 healthcare workers from ten healthcare facilities (five private, five public) in the Bwari Area Council. A random sampling technique was used, and a self-administered questionnaire assessed the participants' knowledge and practices related to healthcare waste management. Data were analyzed using SPSS version 28.0. Results Private healthcare workers demonstrated significantly better knowledge of waste segregation (92.5% vs. 84.9%, p = 0.012) and identifying vaccine containers as medical waste (80.8% vs. 70.8%, p = 0.016) compared to government workers. In practice, a significantly higher proportion of private workers refrained from flushing liquid medical waste into toilets (71% vs. 65%, p = 0.040). In contrast, government workers exhibited more positive attitudes towards waste management, with 99.3% agreeing that medical waste should be properly handled compared to 97.0% in private facilities (p = 0.016). Both private and government workers displayed high knowledge of color coding for medical waste (94.6% vs. 93.5%, p = 0.650), but only 15.1% correctly identified the green color code for general waste. Conclusion Private healthcare workers demonstrated better knowledge of waste segregation, while government workers showed more positive attitudes toward waste handling. Both sectors had similar practices, with gaps in the liquid waste disposal and general waste color coding. Targeted interventions and consistent training are needed to improve waste management practices across both facility types.
... Perilous waste is one whose well-being result is identified with undesired natural and synthetic wellbeing harms over the span of its administration (Halbwachs, 1994).Healthcare waste management is the costeffective method by which the wastes are treated to maintain safe environment and sound public health. The management follows local or international laws and regulations to ensure proper waste collection, transportation, recovery or recycling followed by disposal with proper surveillance and dumping or storing facility (Hasan, Ahmed, Rahman, & Biswas, 2008).The growing number of hospitals, clinics and diagnostic centers in Noakhali city bring to play a cracking impact on community people and environment. Amount of hospital and diagnostic centers waste in tiny than overall waste generated but greater threat on community and health as well as soil water and air (Sayed, Mutahara, & Rahman, 2014). ...
... Except if clinical waste is legitimately dealt with and discarded, it can exhibit dangers to medicinal services staffs, general society, and the environment (Hossain, Santhanam, Norulaini, & Omar, 2011); (Al-Khatib & Sato, 2009); (Shinee, Gombojav, Nishimura, Hamajima, & Ito, 2008).Various investigations have been directed in numerous nations to characterize the best proper clinical waste management plan with the end goal to limit health hazard and related environmental pollution (Hossain, Santhanam, Norulaini, & Omar, 2011); (Bendjoudi, Taleb, Abdelmalek, & Addou, 2009); (Shinee, Gombojav, Nishimura, Hamajima, & Ito, 2008); (Hasan, Ahmed, Rahman, & Biswas, 2008); ( Alago¨z & Kocasoy, 2008).Subsequently, many developed nations have concocted codes of practices and rules for taking care of and transfer such waste (Bdour, Altrabsheh, Hadadin, & Al-Shareif, 2007); (Lee, Ellenbecker, & Moure-Ersaso, 2004); (Hossain, Santhanam, Norulaini, & Omar, 2011).Although critical advancement has been found, yet regardless it requires advance change in all part of clinical waste management practices. However, in most developing nations, clinical waste has not received sufficient consideration in spite of the way that clinical waste marked as hazardous or infectious (Hossain, Santhanam, Norulaini, & Omar, 2011); ( Alago¨z & Kocasoy, 2008); (Silva, Hoppe, Ravanello, & Mell, 2005); (Jang, Lee, Yoon, & Kim, 2006).The management of clinical solid waste is viewed as risky because of its huge volume of age, genuine danger for the human health and also disposal cost (Bendjoudi, Taleb, Abdelmalek, & Addou, 2009); (Silva, Hoppe, Ravanello, & Mell, 2005); (Diaz, Eggerth, Enkhtsetseg, & Savage, 2008); (Jang, Lee, Yoon, & Kim, 2006); (Hossain, Santhanam, Norulaini, & Omar, 2011). ...
Book
A carefully designed survey of Healthcare waste management was undertaken in Noakhali Municipality area, One of the District in Bangladesh. A range of sampling strategies and data gathering techniques were used. The data gathering techniques included observation, formal structured interview and informal dialogue. The shortcomings in the management practices of hospital solid waste in Noakhali were studied by looking at 23 Hospitals and 21 Diagnostic centers as Survey study. Apart from field surveys, the generated hospital waste was weighed to compute the generation rates and was followed through various management practices to the final disposal. The findings revealed a major policy implementation gap between the national government and the hospitals. While modern practices such as landfill and incineration are not used widely, their daily operations were not carried according to minimum standards. Healthcare waste is openly dumped and wastes are burned on landfills instead of being covered with soil. The incinerators used (One Hospital) are also not environmentally friendly as they store wastes over a month to incinerate. The findings further revealed that there is no proper separation of wastes according to their classification as demanded by the national government. The mean percentage of Healthcare segregate waste for handling was found in the following: solid and liquid (61%), hazardous and Non-Hazardous (32%) and toxic and non-toxic (7%) and total waste generation 609.24kg/day. This study proposed establishment of waste disposal site under proper authorization and surveillance with public private partnership that open an opportunity for employment and Environmental safety.
... From both the interviews and observation, it was evident that IDH practices the management of solid medical waste more properly compared to DSH. IDH followed the Bangladesh medical waste management rules more properly than IDH which is in line with the findings of a previous study conducted in Dhaka city where the practices of some of the private hospitals were found to be more appropriate than the public hospitals [10]. Similar findings were also reported by studies conducted in context of other south-east Asian countries like India and Pakistan where the public hospitals were relatively less efficient than most of the private hospitals in medical waste management [11,12]. ...
Article
Full-text available
Background Proper management of solid medical waste is a crucial component of an efficient healthcare system. The objective of the present study was to assess the knowledge, attitude, and practices of medical waste management among the healthcare workers of two selected hospitals of Dhaka city of Bangladesh. Methods This cross-sectional, mixed-method study was conducted in two tertiary care hospitals of Dhaka, Bangladesh–icddr, b Dhaka hospital (Private) and Dhaka Shishu hospital (Public) during November, 2011. A number of 138 healthcare professionals (29 doctors, 80 nurses and 29 cleaners) participated in the study. The study had three parts of data collection: (i) survey with health care workers to determine their knowledge, attitudes, and practices about medical waste management; (ii) in-depth interviews with health officials of infection control committee; and (iii) observation using a facility checklist to determine the current practice of medical waste management. Results Overall, participants from IDH had better knowledge, and practice regarding solid medical waste management compared to DSH. Doctors of IDH demonstrated better knowledge regarding the responsible person for waste management and a better attitude regarding the statement that it was a teamwork (p-value < 0.05). Similarly, nurses and cleaners of IDH showed superior level of knowledge of waste handling as well as safer practices, including consistent use of personal protective equipment. Workers of DSH reported higher incidence of errors and sharp injuries also. From the observation, it was found that IDH authority was more likely to follow the waste management guideline. Poor knowledge and attitude were the major barriers for proper waste management in IDH while lack of funds, human resource and logistics were the major barriers in DSH. Conclusions Both hospitals, particularly DSH, demonstrated significant deficiencies in knowledge, attitude, and practice of proper solid medical waste management. Despite limitations, IDH, exhibited more efficient waste management procedures.
... The healthcare sector also contributes to water pollution by disposing of pharmaceuticals, disinfectants, and biological wastes. Many of Bangladesh's 600 hospitals lack proper waste disposal systems, and as a result, toxic substances enter water bodies and pose health risks (Hassan et al., 2008). ...
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Cholera, a disease caused by Vibrio cholerae, remains a pervasive public health threat, particularly in regions with inadequate water sanitation and hygiene infrastructure, such as Bangladesh. This review explores the complex interplay between water pollution and cholera transmission in Bangladesh, highlighting how contaminated water bodies serve as reservoirs for V. cholerae. A key focus is the potential role of probiotics as a novel intervention approach for cholera prevention and management. Probiotics are promising as an adjunctive approach to existing therapies as they can enhance gut barrier function, induce competitive exclusion of pathogens, and modulate host immune responses. Recent probiotic advancements include engineering strains that disrupt V. cholerae biofilms and inhibit their virulence. Integrating probiotics with traditional cholera control measures could significantly enhance their effectiveness and provide a multifaceted approach to combating this persistent disease. This review aims to shed light on the potential of probiotics in revolutionizing cholera management and to offer insights into their application as both preventive and therapeutic tools in the fight against this enduring public health challenge.
... This situation poses significant risks to public health and the environment. Improper medical waste disposal practices in Uyo City Metropolis have severe environmental implications (Hassan, 2008;Morenikeji et al., 2017). Firstly, the release of hazardous chemicals and pathogens from improperly disposed medical waste can contaminate soil, water bodies, and air, leading to the spread of diseases and ecological imbalances. ...
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Indiscriminate dumping of infectious and toxic medical wastes generated from the hospital as well as open burning of these wastes are becoming prevalent in recent times. This usually result in several health and environmental problems. The objective of this study was to determine the soil elemental compositions in hospital waste disposal sites in Uyo metropolis. The study areas, included Uniuyo Teaching Hospital, St. Luke's Hospital, Uniuyo Medical Centre and Children Hospital. Underlying soil samples in the waste disposal sites were collected in a cellophane bag and tied properly to prevent air ingress. Atomic absorption spectrophotometer was employed to determine trace metals present in the waste disposal sites which were compared to World Health Organization Standards. The results were analyzed using statistical analysis, ANOVA. Results obtained from the atomic absorption spectrophotometer revealed that each of the samples contained one of the following elements such Pb, Ni, Cr, As, Cd, Al. The ANOVA results showed that mean values of the heavy metals were within WHO permissible limit, like lead Pb (1.302) at the children hospital site, Nickel Ni (0.448) at Uniuyo Teaching Hospital site, Aluminum Ai (0.486333) at the Uniuyo Medical Centre site, Arsenic As (0.239333) at the control site. Except chromium Cr (0.343667) at the children hospital site that was above the WHO standard. From the result of the statistical analysis, it was observed that medical wastes had a significant effect on the environment of Uyo metropolis. Based on the findings, it is recommended that effective method of waste segregation and disposal should be implemented, and designated sites should be used as dump sites.
... [9,11,16,19,23] , In Sahloul University Hospital, we have embraced a waste segregation system at the source, employing color-coded high-density polyethylene bags and bins for easy identification and separation of infectious and non-infectious waste. Infectious waste is carefully packaged to mitigate potential injury and the transmission of diseases [24]. Standard color-coded plastic bags (black for general waste and yellow for infectious waste) and sharps containers are consistently distributed to various hospital departments. ...
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Background Healthcare waste (HCW) poses a global hazard, particularly in developing country hospitals where mismanagement is common due to poor practices among staff. Training healthcare workers has shown promise in enhancing practices and behaviors. The aim of this study was to assessHCW management at Sahloul University Hospital (2019–2021) before and after training sessions. Methods This study was conducted at Sahloul University in Sousse, Tunisia, spanned two years (2019–2021) and consisted of three distinct stages. Two audits of Healthcare Waste Management (HCWM) were conducted using a predetermined assessment framework derived from ANGED’s guidelines, with an educational session separating the two audits. Results In terms of sorting practicesthere was a substantial improvement in sorting practices following training. Specifically, the overall compliance rate for sorting sharps increased from 60.3 to 77.6% (p < 10 − 3), and for sorting soft and solid waste, it rose from 32.5 to 72.4% (p < 10 − 3) in 2021. Overall, resource indicators demonstrated improvement between 2019 and 2021, the compliance rate for the intra-service collection step increased from 31.3 to 58.2%. However, we observed persistent inadequacies in container and bag labeling, as well as challenges in tracing the time of healthcare waste collection. Conclusion Training led to significant improvements in HCW management practices among healthcare workers, though some areas still need enhancement.
... In particular, the fact that there were decreases in the positive answers given to the topics of considering their own knowledge sufficient, the effect of information on reducing medical waste generation and thinking that the problem in reducing medical waste is lack of information shows that the training increased the awareness of the participants on these issues. Our findings are in line with studies indicating that awareness rather than knowledge is weak in medical waste reduction.Hassan et al. revealed that medical waste problems arise due to lack of awareness and reluctance of healthcare workers and unclear policies and laws [32]. During the 35 days following the end of the training, the ratio of medical waste to general waste decreased from 70% to 68%, while the ratio of recyclable waste increased from 19% to 21% (Fig. 1). ...
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Full-text available
Objectives: This study aims to investigate the effectiveness of peer education methods in reducing medical waste in operating room settings. Methods: A quasi-experimental design was utilized, involving 217 operating room staff who received training in medical waste management through a peer education program. Changes in knowledge, attitudes, behaviors, and the amount of medical waste generated before and after the intervention were evaluated. Results: Following peer education, there was a significant increase in participants' knowledge levels regarding proper medical waste segregation. Positive shifts in attitudes and behaviors related to medical waste management were observed post-training. Additionally, the ratio of medical waste to general waste decreased, while the proportion of recyclable waste increased after the intervention. Conclusions: Peer education emerges as an effective method for enhancing awareness and promoting proper medical waste management practices among operating room staff. However, achieving significant waste reduction requires comprehensive approaches beyond education alone. Clear regulations, improved infrastructure, and the adoption of reusable products are crucial for sustainable waste reduction efforts in healthcare settings.
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