Issues of medical waste management

The volume of medical waste generated in the clinics, hospitals and other healthcare establishments have been increasing in the country. Medical wastes may contain sharp, non-sharp metallic items, human body fluids, dressing materials, surgically removed body parts, chemicals, pharmaceuticals, medical devices and radioactive materials and various types of plastics, glass etc.. Medical wastes could be infectious and harmful for public health and therefore they need special care (for segregated and safe collection and storage) at the source of generation and for their further management. Medical wastes are generated in solid or liquid form but in most cases in Dhaka and in other cities and towns of the country, the solid parts of the medical wastes are collected and managed separately.  Unfortunately, not all the cities and towns have organised form of medical waste collection and management facilities, so far. Moreover, the medical wastes are stored as mixed waste and dumped untreated along with other domestic and industrial solid wastes in the open landfills (in fact most of the towns and cities do not have sanitary landfill locations dedicated for waste disposal).

Until 2004 there were no organised form of medical waste collection and disposal in the country including in Dhaka. Since 2005, a local NGO Prism Bangladesh Foundation have been engaged by Dhaka City Corporation for collecting and disposal of medical solid wastes in Dhaka city. Later the Prism Bangladesh Foundation has extended its services in Rangpur, Rajshahi, Narayanganj, Savar, Jessore and Sylhet with support from the relevant city corporations. Prism has signed contracts with all the major hospitals, clinics and healthcare facilities located in the cities and towns mentioned above for collectiilon and disposal of the medical wastes against a certain fee for the services. There are a few (including dental and small clinics) who do not take the services of Prism Bangladesh Foundation and dispose their medical wastes along with general waste without special care.

Approximately 13.5 tons of medical wastes are collected daily from hospitals and clinics and healthcare facilities in Dhaka city (Dhaka South City Corporation and Dhaka North City Corporation). A study of Dhaka South City Corporation suggests that approximately 50 tons of total solid wastes are collected daily by both Dhaka North and Dhaka South City Corporations. Prism Bangladesh Foundation and Dhaka South City Corporation officials responsible for medical waste collection and their management have been observing that the major parts of the recyclable medical wastes (mainly plastic products) are generally not provided to Prism Bangladesh Foundation along with other medical wastes by the public hospitals. Therefore, it can be anticipated that the recyclable medical wastes are separated from the medical waste by the public hospital staffs and they sell them to other users.

Dhaka South City Corporation has allocated a special site at Matuail sanitary landfill area for safe management and disposal of medical waste there. Prism Bangladesh Foundation collect and carry different types of medical wastes from different locations of Dhaka City to Matuail landfill site, segregate them and manage them further. The wet part of medical wastes are put into an autoclave chamber to disinfect them for further disposal at the landfill. On the contrary, sharp (middle, glass etc.) items, body parts are buried at designated sites of the Matuail landfill. Recyclable plastic items are separated and chemically treated, shredded and sold as raw materials for plastic factories. All other dry items from medical wastes are incinerated and the ash are buried at the landfill. Matuail sanitary landfill site designated for medical waste management has its autoclave, incinerator and effluent treatment plant (ETP for treating waste water) for safely managing medical wastes generated and collected by Prism Bangladesh Foundation in Dhaka city.

The collaboration between Dhaka City Corporation and Prism Bangladesh Foundation has set an example to other city corporations and municipality to manage safely their medical wastes. Unfortunately, major parts of the city and municipal authorities, so far, lack organised and safe management infrastructure for their medical waste. It causes concern but the responsible authorities consider the issue as a less priority issue. Not all of the hospital and clinics in the country have arranged necessary training for their staff for developing and practising segregated storage and handling of medical waste in their respective premises.

Unsafe handling and disposal of medical waste may offer threat to public health. Improper handling of medical waste invites special threat of spreading Covid 19 to medical staff and people who handle the waste. Moreover, mismanagement of the infectious medical wastes may lead to rapid spread of infectious diseases like typhoid, cholera, hepatitis, AIDS and other diseases. Medical waste materials thrown to open landfills and water bodies may help infection to penetrate the food chain and invite disastrous consequences for public health and safety in our environment.

There are a number of organisations including the management of hospitals and clinics, Department of Health, Department of Environment, City Corporations and municipal authorities for proper management and monitoring of medical wastes in the country. The Government of Bangladesh has enacted 'Bangladesh Medical Waste Management and Processing Rules 2008 to deal with medical waste collection and disposal in the country. Not all medical establishments follow the requirement of the rules for segregated storage of medical wastes in separate covered bins (with different colours depending on the types and nature of medical waste). Also, city corporations and municipal authorities should have established separate sanitary landfill sites for secure and safe medical waste disposal. Unfortunately, only Dhaka South City Corporation has, so far, a dedicated medical waste management arrangement at Matuail (to accommodate and manage medical wastes from Dhaka North and Dhaka South City Corporations).

A single NGO, Prism Bangladesh Foundation alone can not manage all the medical wastes generated in the country due to its limited capacity. City corporations and Municipal authorities need to dedicate budget and infrastructure to help properly manage the harmful medical wastes. At the same time, hospitals and clinics should develop necessary infrastructure and train their staff for safe storage and handling of medical wastes. Department of Health and Department of Environment should coordinate with respective city corporations and municipal authorities to monitor proper implementation of the Bangladesh Medical Waste Management and Processing Rules 2008. Encouraging a number of third party organisations like Prism Bangladesh Foundation may help the concerned authorities to properly collect and manage the medical wastes.

Mushfiqur Rahman is a mining engineer, writes on energy and environment issues. [email protected]