Hospital Waste Management

INTRODUCTION:
A HOSPITAL is a service-oriented residential establishment that provides medical care facilities
comprising of observational, diagnostic, therapeutic and rehabilitative services for persons
suffering from or suspected to be suffering from any kind of disease or injury. The basic concepts
of waste management in a hospital do not differ basically from that in hotels, schools and catering
establishments since certain areas of the hospital render the same type of basic services. But some
wastes generated in a hospital are too hazardous to be treated negligently, and any carelessness in
the management of these wastes in a hospital tend to spread infections and contaminate the entire
living environment prevailing in a hospital. The delay in the recovery and overburden of weak
patients, endanger the patients’ survival and may also generate health hazards to personnel
working in and around the hospital environment. Although some degree of attention is given on
the cleanliness of patients’ hospital wards, premises, laboratories, operation theaters, closets etc.
and on the supply of safe drinking water in some hospitals/clinics in Dhaka but adequate emphasis
is not given in most cases for the proper management of generated wastes and particularly the
disposal of hazardous solid wastes. It is observed that the solid clinical wastes are being disposed
off in the City Corporation’s collection bins in and around the hospital premises. The waste is then
collected by the City Corporation’s Vehicles and then transported to the open municipal dumping
sites. The management of hospital waste requires its removal and disposal from the health care
establishments as hygienically and economically as possible, by methods that all stages minimizes
the risk to public health and to the environment. This study encompasses on an in-depth analysis
of the present conditions of waste management systems of selected hospitals in Dhaka city and an
assessment of different cost-effective options for proper management of hospital waste in the
prevailing condition in Dhaka city. Furthermore, in healthcare units the direct exposure of waste
management workers and members of the public to this type of waste increases the hazard that
emerges from their treatment. Despite the fact that current medical waste management practices
differ from hospital to hospital, the problematic areas are approximately the same for all healthcare
units and at all stages of management, including segregation, collection, packaging, storage,
transport, treatment and disposal. In Dhaka, considerable problems exist in this area, as little action
has been taken to apply a complete system of hospital waste management. The recently passed
Joint Ministerial Decision 37591/2031/03 regarding the measures and conditions for the
management of healthcare waste can be considered as the first important step in this direction.
Objective:
To observe the waste management and general system.
Present Status of Hospitality waste management:
Dhaka, the capital of Bangladesh, is expanding very rapidly. The present population of Dhaka city
is estimated at around 8 million with a very high annual growth rate of about 5.6 per cent as
compared to the countries overall growth rate of 2.17 per cent per year. Compared to demand of
this huge population, health care facilities in Dhaka are quit inadequate. In recent years rapid and
mushrooming growth of private clinics/ hospitals have tended to alleviate this problem to some
extent. There are about 250 healthcare centers in Dhaka city that includes hospitals, clinics, nursing
homes, dental hospitals etc. But inadequate waste management systems in these healthcare
facilities are posing a serious threat to public health as well as to the environment. It is being
observed that a large number of private clinics are housed in renovated residential buildings and
most of them do not have the facilities for adequate waste management. More than 98 per cent of
the health care establishments in Dhaka simply dispose off their waste into the dustbins of city
corporation. the status of hospital waste management in Dhaka, the capital city of Bangladesh,
presents a mixed picture characterized by both challenges and ongoing efforts to improve waste
management practices. Many healthcare facilities in Dhaka face infrastructure deficiencies,
including inadequate waste segregation facilities, lack of proper storage areas, and limited access
to treatment and disposal facilities. This hampers the effective management of medical waste and
increases the risk of environmental pollution and public health hazards. Despite the existence of
regulations governing hospital waste management, compliance and enforcement mechanisms in
Dhaka remain insufficient. This leads to inconsistent waste management practices across
healthcare facilities and contributes to the improper handling and disposal of medical waste. There
is often limited public awareness about the importance of proper hospital waste management and
the potential health and environmental risks associated with improper waste disposal. This lack of
awareness contributes to irresponsible waste disposal practices among both healthcare workers
and the general public. The involvement of the informal sector in waste collection and recycling
poses challenges to proper waste management practices in Dhaka. Informal waste workers may
lack training and use unsafe methods for handling medical waste, leading to increased risks of
exposure to hazardous materials. Many healthcare facilities in Dhaka face financial constraints
that limit their ability to invest in modern waste management technologies and infrastructure. This
makes it difficult to implement sustainable waste management practices and upgrade existing
facilities to meet regulatory requirements. Various capacity building initiatives, including training
programs and workshops, are being conducted in Dhaka to educate healthcare staff about proper
waste management practices. These initiatives aim to enhance awareness, skills, and compliance
with waste management regulations among healthcare workers. Efforts are underway to improve
infrastructure and facilities for waste management in healthcare facilities across Dhaka. This
includes the establishment of central waste treatment facilities, provision of essential equipment
such as autoclaves and incinerators, and construction of dedicated waste storage and disposal areas.
The government of Bangladesh has taken steps to strengthen regulations governing hospital waste
management in Dhaka. This includes the enforcement of existing regulations and the development
of new guidelines to address emerging challenges in waste management practices. Educational
campaigns and outreach programs are being conducted in Dhaka to raise public awareness about
the importance of proper waste management and the potential health and environmental risks
associated with improper waste disposal. These campaigns aim to foster community support for
waste management initiatives and promote responsible waste disposal practices. Research
institutions and academic organizations in Dhaka are conducting research on innovative waste
management technologies and strategies tailored to the local context. These efforts aim to develop
cost-effective and sustainable solutions for managing medical waste in Dhaka's healthcare
facilities.
Categories of Hospital waste:
In this study, attempts have been made to classify the wastes into two general categories because
personnel associated with waste manage of hospital can identify these waste more easily: Non-
hazardous (general) waste – domestic type waste; packing materials, non-infectious materials, that
do not pose special handling problems to human health or the environment. Hazardous waste -
which includes infectious waste (contains pathogens in sufficient concentrations that exposure to
it could result in disease), pathological waste (include blood, body fluids, tissues, organs, body
parts, etc.), sharps (needles, blades, syringes, scalpels, saws, broken glass, nails and any items that
could cause a cut or puncture), and very small amount of pharmaceutical and chemical wastes.
Proper management of these categories of
waste is crucial to prevent health risks to healthcare workers, patients, waste handlers, and the
general public, as well as to protect the environment. The categories of hospital waste in
Bangladesh include:
General Waste: General waste, also known as non-hazardous or non-clinical waste, includes
materials that are not contaminated with blood or other potentially infectious substances. This
category of waste originates from administrative areas, offices, cafeterias, and other non-clinical
sections of healthcare facilities. General waste typically consists of items such as paper, cardboard,
plastic, food waste, packaging materials, and other common household-type waste. While general
waste may not pose direct health risks, proper disposal methods are still necessary to manage it
efficiently and minimize environmental impact.
Infectious Waste: Infectious waste, also referred to as biomedical waste or hazardous waste,
includes materials that are contaminated with potentially infectious agents. This category of waste
is generated from various healthcare activities, such as patient care, laboratory procedures, and
medical research. Infectious waste may include items such as used bandages, gloves, gauze,
dressings, cultures, swabs, and any other materials that may be contaminated with blood, body
fluids, or infectious microorganisms. Proper segregation, handling, treatment, and disposal of
infectious waste are essential to prevent the spread of infections and protect public health.
Sharps Waste: Sharps waste consists of items that can cause puncture or cuts, such as needles,
syringes, lancets, scalpels, and broken glass. This category of waste poses significant risks of
injury and infection to healthcare workers, patients, waste handlers, and the general public if not
handled properly. Sharps waste must be segregated, collected, and disposed of in puncture-
resistant containers to minimize the risk of accidental needle-stick injuries and potential
transmission of bloodborne pathogens such as HIV, hepatitis B, and hepatitis C.
Pathological Waste: Pathological waste includes human or animal tissues, organs, body parts,
and anatomical waste generated from surgeries, autopsies, and pathological laboratories. This
category of waste may also include products of conception, fetal remains, and other biological
specimens. Proper containment, handling, treatment, and disposal of pathological waste are
necessary to prevent the spread of infectious diseases and protect public health and safety.
Pharmaceutical Waste: Pharmaceutical waste comprises expired, unused, or contaminated
medications, drugs, and pharmaceutical products. This category of waste may also include empty
medication vials, ampules, IV bags, and other pharmaceutical packaging materials. Improper
disposal of pharmaceutical waste can lead to environmental contamination, groundwater pollution,
and adverse effects on human health and wildlife. Pharmaceutical waste must be segregated,
collected, and disposed of using appropriate methods to prevent diversion, misuse, or
environmental harm.
Chemical Waste: Chemical waste includes hazardous chemicals, solvents, disinfectants,
laboratory reagents, and cleaning agents used in healthcare facilities. This category of waste may
also include spilled or unused chemicals, expired disinfectants, and other chemical-containing
materials. Chemical waste poses risks to human health and the environment if not managed
properly. Safe handling, storage, labeling, and disposal practices are essential to minimize
exposure, prevent pollution, and comply with regulatory requirements.
Radioactive Waste: Radioactive waste is generated from healthcare facilities that utilize
radiation-based diagnostic and therapeutic procedures, such as nuclear medicine, radiation therapy,
and radiology. This category of waste may include contaminated materials, shielding devices,
protective clothing, and other items exposed to radioactive materials or ionizing radiation. Proper
containment, handling, storage, transportation, and disposal of radioactive waste are necessary to
prevent radiation exposure, protect public health, and comply with regulatory requirements.

Quantity of Hospital waste:

The quantities of different categories of hospital wastes in Dhaka city are estimated on the basis
of the data collected from selected hospitals/clinics from an intensive survey extending over 7 to
10 days during the March to May 1998 period are shown in Tables 1 and 2. These wastes were
collected 3 times a day. The average generation rate (kg/ bed/day) of total hospital waste was about
1.2 which is much lower than that of 4.5 in USA, 2.7 in Netherlands and 2.5 in France. However,
the average hospital waste generation rates are in the range of 1 – 4.5 kg/bed/day in Latin American
countries like Chile, Brazil, Argentina, Venezuela (Montreal, 1991). But the percentage of
hazardous waste in Dhaka city (15.5 per cent) is much higher than that of Netherlands (5 per cent)
and Sweden (9 per cent), and is lower than that of Denmark (25 per cent) and USA (28 per cent),
and is very close to the rate of generated in Germany(14 per cent). The indicated difference may
be due to geographical location, living habits and standards, availability of different treatment
facilities, and perhaps to the ways in which solid wastes are categorized in different countries.
Estimating the precise quantity of hospital waste generated in Bangladesh can be challenging due
to factors such as variations in healthcare facility size, patient load, medical procedures performed,
waste management practices, and available data sources. However, several studies and
assessments have provided insights into the approximate quantity of hospital waste generated in
the country. According to a report published by the World Health Organization (WHO),
Bangladesh generates an estimated 0.6 to 0.7 kilograms of healthcare waste per hospital bed per
day. With approximately 126,000 hospital beds in the country, this translates to a total daily
generation of healthcare waste ranging from 75,600 to 88,200 kilograms. Hospital waste in
Bangladesh is typically categorized into various types, including general waste, infectious waste,
sharps waste, pathological waste, pharmaceutical waste, chemical waste, and radioactive waste.
The distribution of waste types varies depending on factors such as the type of healthcare facility,
the nature of medical procedures performed, and waste management practices employed.
Infectious waste, which includes materials contaminated with potentially infectious agents such as
blood, body fluids, and microbiological cultures, constitutes a significant portion of hospital waste
in Bangladesh. Studies have estimated that infectious waste accounts for approximately 15% to
25% of total healthcare waste generation in the country. Sharps waste, consisting of items such as
needles, syringes, scalpels, and broken glass, poses significant risks of injury and infection if not
managed properly. Sharps waste generation in Bangladesh is influenced by factors such as the
prevalence of injection-based medical procedures and the use of disposable medical devices.
Studies have reported that sharps waste accounts for approximately 1% to 5% of total healthcare
waste generation. Pharmaceutical waste, including expired, unused, or contaminated medications
and pharmaceutical products, is another significant component of hospital waste in Bangladesh.

Fig: Raju Hospital has all waste storage containers(Charabagh, Dhaka).

Background of Hospital Management:
Hospital waste management is one of the most neglected part of the managerial process in
Bangladesh. Neither the government nor hospital authorities pay proper attention to this matter.
Unhygienic waste disposal by many hospitals, clinics and healthcare centers in Dhaka are posed
serious health hazard to the city dwellers in general and to the people living within and in the
vicinity of the hospitals in particular. Almost all of these hospitals are disposing every kind of
wastes (hazardous, non-hazardous, infections, sharps etc.) in nearby municipal dust bins without
any pretreatment whatsoever. An unhealthy and hazardous environment exists in and around these
hospitals, affecting patients, hospitals staff and other people. Scavengers who collect waste from
dust bins are at risk from sharps, pharmaceuticals and chemicals and from direct contact with
infectious materials. Also, recycling of infectious objects may pose serious health hazard to their
users. Liquid hospitals wastes are disposed directly to the municipal sewer system in most of the
hospitals in Dhaka city. Chemicals used in hospitals is a potential source of water pollution (WHO,
1983). Direct disposal of faces and urine of infectious patients in municipal sewer system may
cause outbreak of epidemic diseases. It is evident from the field survey that the hospital authority
of SSMCH, commonly known as Mitford Hospital, in the old part of the Dhaka city takes full
advantage of the hospital’s location by dumping refuse in the river Buriganga. DMCH garbage is
seen to be dumped at various corners of its premises. Sweepers of the hospital collect garbage from
these spots inside the hospital premises and then throw them in the roadside dustbins. Disposable
syringe, needles, bloodsoaked pads, used blood bags and such other materials are simply thrown
in the open dustbins. The disposal of such hazardous portion of wastes from hospitals into public
waste disposal system expose the people to serious health risk. In Bangladesh a huge amount of
waste material is recycled and reused in solid waste management system. It is being reported by
Tieszen and Gruenberg (1992) that substitution of reusable products for disposable and recycling
of paper would result in a 93 per cent reduction in surgical waste. Reliance on reusable is reported
to lower costs significantly since costs to wash or disinfect items for reuse is less than that of
purchasing new disposable items (Tieszen and Gruenberg, 1992 and DiGiacomo et al, 1992).
DiGiacomo et al (1992) also reported that a single teaching hospital saved over $100, 000 a year
by returning to reusable scrub suits and gowns in the operating room. The recycling operation has
become a trade on which a large number of people (or scavengers) are dependent in Dhaka. The
scavengers engaged in recycling operation are extremely poor, do not have education, and unaware
of harmful consequences of exposure of contaminated and hazardous waste (Rahman,1996). From
field observations it was concluded that there had been injuries from sharps, broken glasses, etc.
In case of recycling operation, suffering from worm infections, skin disease, diarrhoea, chronic
dysentery, viral hepatitis, etc. have been reported. Recycling operations in Dhaka city are quite
satisfactory. However, measures should be taken to minimize these health hazards.
The health professionals involved in hospital or in different authorities, monitoring and controlling
the city environment have societal responsibility to address these critical issues more carefully.
Again, different voluntary organizations could also participate to provide hygiene education to
hospital staffs involved in waste management and also to the poor scavengers. This type of
education can be provided through posters and mass media, to which every person now has access.
This would enable them to handle the waste materials in an scientific way. This study reveals that
only about 15 per cent hazardous portion (Tables 1 and 2) of total wastes from hospitals require
special attention for their proper disposal. The remaining portion of wastes can be easily disposed
off into the municipal dust bins if they are carefully segregated. Thus a few changes in material
procurement process in hospitals, mandatory staff education in waste segregation, proper hygiene
education to the scavengers, treatment of selected hazardous materials, and such other few efforts
can get healthcare establishments off the list of major hazardous materials to be disposed off to the
municipal dust bins. Once these are properly segregated, the hazardous portion can be treated by
different treatment options (e.g. chemical disinfection, autoclaving, microwaving, incineration,
etc.). Any one of them or a combination of one or more of these options can be employed by
different hospitals. Again a commercial combined waste treatment system can be maintained in
each city for the disposal of hazardous portion of hospital wastes. It can be mentioned that the use
of commercial incinerators is expected to increase as more stringent regulations lead to shutdown
of many uncontrolled on-site medical waste incinerators in USA. An assessment of cost
effectiveness of different treatment options (autoclaving, microwaving and incineration) indicates
that the treatment of hazardous waste in a centralized incinerator appears to be one of the best
treatment options (Ullah, 1999). However, the system has to be maintained properly with
appropriate air pollution control apparatus/device. Thus the health care waste management
requires a systems approach, the handling, storage, transport, treatment and disposal of waste by
methods that at all stages minimize the risk to public health and to the environment. However, the
transport of these wastes to the treatment sites should be the responsibility of competent waste
management authorities. To improve overall hospital waste management system in Bangladesh, it
is essential that different authorities (both government and private) involved in hospital and private
clinic development and in monitoring and controlling the Bangladesh environment should
recognize the nature of the problem for the development of legislation to regulate hospital
sanitation. Hospital waste management in Bangladesh faces several challenges. Many healthcare
facilities in Bangladesh lack adequate infrastructure and resources for proper waste segregation,
storage, treatment, and disposal. The absence of dedicated waste management facilities, such as
incinerators or autoclaves, hampers the safe handling and disposal of hazardous medical waste.
While regulations governing hospital waste management exist in Bangladesh, enforcement
mechanisms may be weak, leading to inconsistent compliance with waste management guidelines.
The lack of monitoring and oversight contributes to improper waste disposal practices and
environmental pollution. Healthcare staff may lack awareness and training about proper waste
management practices, including segregation, handling, and disposal procedures. Inadequate
training increases the risk of improper waste segregation, leading to the mixing of hazardous and
non-hazardous waste streams. Many healthcare facilities in Bangladesh face financial constraints
that limit their ability to invest in modern waste management technologies and infrastructure. The
high cost of purchasing and maintaining waste treatment equipment, such as incinerators or
autoclaves, poses challenges for resource-constrained facilities. The involvement of the informal
sector in waste collection and recycling poses challenges to proper waste management practices.
Informal waste workers may lack training and use unsafe methods for handling medical waste,
leading to increased risks of exposure to hazardous materials. Despite these challenges, several
initiatives have been undertaken to improve the government of Bangladesh has introduced
regulatory reforms to strengthen hospital waste management practices. The Hospital Waste
Management Rules 2008 provide guidelines for the segregation, handling, treatment, and disposal
of medical waste in healthcare facilities. Efforts are underway to improve infrastructure and
facilities for waste management in healthcare facilities across Bangladesh. This includes the
establishment of central waste treatment facilities, provision of essential equipment such as
autoclaves and incinerators, and construction of dedicated waste storage and disposal areas.
Capacity building programs and training initiatives are being conducted to educate healthcare staff
about proper waste management practices. These programs aim to enhance awareness, skills, and
compliance with waste management regulations among healthcare workers. Educational
campaigns and outreach programs have been launched to raise public awareness about the
importance of proper waste management and the potential health and environmental risks
associated with improper waste disposal. These campaigns aim to foster community support for
waste management initiatives and promote responsible waste disposal practices.

Study of Hospital Waste Management:

This study investigated medical waste management (MWM) practices in Bangladesh: its present
constraints, the health effect of existing practices, and the weaknesses of the current system.
Suggestions for improvement of the MWM situation have also been offered. Those interviewed
included hospital staff, waste pickers and local residents. In‐depth field observations and a
questionnaire survey were conducted in June‐July 2000 and March 2001. Laboratory analyses of
medical waste were done on different occasions from 1998‐2001. Analyses of medical waste
showed severe contamination of pathogenic microorganism and respondents suffered from various
infectious diseases. The study identified the absence of rigorous laws related to MWM practices.
It is a necessity to improve the handling and disposal methods of medical waste in almost all the
available medical facilities. Medical waste generated from diagnosis, monitoring and preventive,
curative or palliative activities in field of the veterinary and human medicine include infectious,
hazardous and benign materials. Improper disposal of wastes in hospitals places direct and indirect
health impacts on those working in hospitals and the surrounding communities, and on the
environment. Such practices contribute to the spread of disease, as well as pollution of the air, soil
and water. Runoff from untreated infectious wastes or human excrement dumped on the land can
contaminate surface and ground water supplies, exposing the population to the risk of diseases and
parasites. Unintentional injuries may occur due to the exposure of improperly discarded sharps
leading to life‐threatening infections such as HBV, HCV and HIV (World Bank, 2000). The re‐
use of unsterilized syringes results in 8‐16 million hepatitis B, 2.3‐4.7 million hepatitis C and
80,000‐160,000 HIV infections annually (WHO, 2000). Uncontrolled burning of medical waste
pollutes the air with acid gases, dioxins, furans and heavy metals.
There are currently 645 public and 288 private sector health care establishments in Bangladesh
(Line Director (hospital services), 2000). Most have no provision for safe disposal of medical
waste, yet its generation has been on an increase. An estimated 255 tons of medical waste is
generated in Dhaka every day (Rahman and Ali, 2000), most of which is dumped in municipal
bins (ADB, 1998), since only few hospitals have onsite management system such as burning,
burial, autoclave and/or waste segregation.
An overwhelming number of the urban poor in Bangladesh rely on the collection of secondary
materials for their primary source of livelihood. The wastes pickers sort through waste on site;
usually open dumps. They sell all that can be recycled to agents of various industries. The waste
pickers adopt no protective clothing, exposing themselves to injury and sickness. Moreover, the
municipal dustbins of Dhaka, where the hospitals place their waste (including human body parts
(Rashid, 1996)) are left exposed to the environment for days before collection (ADB, 1998; Akter
et al., 1999). This increases the risk of epidemics such as viral hepatitis, typhoid, pneumonia and
AIDs (ADB, 1998).Study was conducted in two major cities of Bangladesh: Dhaka, the capital
city, and Khulna, a port city southwest of Bangladesh. There are 26 government hospitals and
foundations, 133 private hospitals and clinics and 318 diagnostic centers in Dhaka. There are 248
health facilities in Khulna of which 21 are hospitals and clinics (which house the in‐patient bed
system), 12 are diagnostic centers and the remainder are maternity centers, centers for the
Expanded Program on Immunization (EPI), and out patient departments (OPD). A total of 14
hospitals, clinics, diagnostic centers and research institutes from Dhaka, and seven from Khulna
were selected for this study (Table I) Dhaka. Four government hospitals (covering 2,350 beds i.e.
61 percent of total government hospital beds in Dhaka), one private hospital (national institute and
hospital), two private clinics and two diagnostic centers were selected to represent each category
in this study. These cover approximately 30 percent of total beds. The government hospitals
represent the management system of the country. They were also selected for the questionnaire
survey, interview, waste sampling, and field observation. In addition, a health institute, an
international research center, a military hospital, a clinic and a diagnostic center were selected for
interview and field observation Khulna. Total bed number in the 21 hospitals and clinics are
approximately 806, of which 62 percent (500 beds) belongs to three big hospitals (one district and
two private). Of these three, two hospitals covering 70 percent (350 beds) of 62 percent were
studied. Three private clinics were selected from the remaining 38 percent of beds (42 percent of
38 percent (130 beds)). Therefore, total coverage for this study was 78 percent of all beds present
in the city. Four private hospital and clinics, two diagnostic centers and one government district
hospital were selected for interview and field observation. Khulna was also selected for a case
study of MWM.
The three dumpsites in the country were examined: city corporation's landfill sites at Kamalapur
and Matuail in Dhaka and the municipal dumping site at Khulna.
Data were collected through field observations, interviews, and questionnaire survey during June‐
July 2000 and March 2001:
Field observations. Made at each location using a checklist focusing on potential problems posed
by disposal of medical waste. Emphasis was placed on waste generation in the hospitals (store,
OPD, patient ward, operation theatre, pathological laboratory), disposal practices, and disposal
sites. The MWM project of an NGO at Khulna (Prodipan) was visited. Hospital management
authority, divisional head/director, senior administrative personnel of the hospitals or clinics were
interviewed on general hospital management, health services, waste management, their basic
understanding and view on MWM, and their suggestions for improvement the system. City
Corporation, Department of Environment (DOE) officials, and Directorate General (DG) health
officials were also interviewed for the legal status and for their awareness of the importance of
proper MWM.Questionnaire survey. Conducted for those providing medical services, handling
and disposing waste (doctors, nurses and waste pickers). Sets of semi‐structured questionnaires
were used. The main purpose was to assess the level of awareness of health effects of improper
disposal, the required skill for waste handling, and to identify the factors limiting proper disposal.
Application of the above formula with the specified values, which in fact maximizes the sample
size, yielded a total required sample of 255 respondents from the total 4,313 hospital staff. This
sample was divided into doctors, nurses and others in the proportion as they appear in the
population. The collected sample size was 385 persons comprising 55 doctors, 155 nurses and 179
others (cleaners, ward boys). Assuming 50 percent reserve (from non‐response and missing staff)
from the required sample size giving 383 as requirement (255 * 1.5=383 persons). Other than
these, 117 waste pickers/local residents near hospital vicinity and 100 of those from two municipal
dumping sites at Dhaka were selected when available.Samples of solid waste, wastewater, and
leachate from the hospitals, waste disposal bins, disposal sites and dumping sites were collected
for pathological (microbial) analysis. during September 1998, July 2000 and March 2001 in
accordance with the International Center for Diarrhoeal Disease Research, Bangladesh's
(ICDDR,B's) prescribed technique. Total coliform, faecal coliform, faecal streptococci,
mycobacteria, amoeba, Vibrio spp., Salmonella spp. and Shigella spp. were analyzed using the
standard methods as adopted by environment and microbiology laboratory of ICDDR,B. It was
found that the tertiary hospitals generated general wastes such as food residues,
vegetables/rubbishes, paper, cans and other metals, infectious wastes- pathological wastes,
contaminated dressing materials, bandages, sticking plaster, gloves, disposable medical items,
contaminated packaging and other soiled wastes (wastes contaminated with blood and other body
fluids), sharps (used syringes, used hypodermic needles, needles, surgical blades and blood lancets
broken bottles and glasses) and recyclable wastes (plastic items) and small quantities of
pharmaceuticals. The study found that on average 641 kg waste is generated per day in the tertiary
hospitals in Bangladesh. On average 1 kg waste was generated per day per bed out of which 79
percent consisted of general waste, 8 percent were infectious waste, 3 percent were sharp and 10
percent were recyclable waste. The generation of medical waste per day ranges from 0.76 kg to
1.16 kg per bed. The Dhaka Medical College Hospital generated the highest quantity of total waste
with 1.16 kg/day/bed of which general waste was 0.96 kg/day, infectious waste was 0.11
kg/day/bed; sharp was .04 kg /daybed and recyclable waste was 0.12 kg/day/bed. The study
reported that Bajitpur Medical College generated the lowest quantity of waste.

Among the government tertiary hospitals under this study, Dhaka Medical College Hospital
(DMCH) produced highest quantity of waste; the reason might be the highest patient-load that was
3 to 4 times of its bed capacity with increasing attendant’s crowding in relation to the number of
patients. It is a tertiary level government hospital, which, besides its normal patients, provides
services to the referral patients from all over the country, since it is less expensive and has got the
opportunity of having multiple departments for treatment for mostly all types of diseases.

It was found that about 27% tertiary hospitals segregated pathological wastes in the wards, while
about 18% cases, segregation took place at the time of generation and for about 9% cases it was
done at the time of collection. About 51% of the sample hospitals segregated sharp equipment in
the wards of which about 31% hospitals used to segregate sharp wastes at the time of generation
in wards and other places; and about 20% hospitals segregated at the time of collection. About
20% hospitals segregated general wastes, of which about 13% cases, it was done at the time of
collection and about 7% cases, segregation took place at the time of generation. In case of
recyclable waste, about 49% hospitals had segregation practices, of which about 31% cases, wastes
were segregated at the time of collection and about 18% cases it was done at the time of generation.
None of the hospitals were found using colour coded container for segregation. Waste was
normally kept in ‘balti’, bins, buckets, bags and in other containers. In tertiary hospitals, mostly
(78% cases) wastes (both hazardous and non-hazardous) were collected by respective city
corporation or municipal authority together with municipal solid wastes. In very few cases (11%)
it was done by local NGO/NGOs and about 11 percent health care facility itself collect hospital
waste. Almost all tertiary hospitals, irrespective of government and non-government, left their
wastes (mixed waste) in the nearer municipal dustbins and assigned respective staffs from city
corporation/municipality collected it from the dustbins.

In all category hospitals, biomedical wastes were collected and handled by both permanent and
temporary stuffs (Sweepers or Cleaners). In many cases particularly in government hospitals, due
to inadequate number of sweepers or cleaners, sometimes temporary cleaners were employed on
daily basis for this job. Moreover as these temporary cleaners have no fixed responsibility and
receive insufficient salary, they do the job improperly and irregularly. In all studied government
healthcare facilities and most of the non-government health care facilities (HCFs), all types of
wastes were transported to the temporary storage or dustbin outside hospital premises using
trolleys or ‘balti’ or plastic bins or big bowls (for small amount) without any disinfection.
Permanent or temporary/daily-basis sweepers or cleaners or ‘ayas’ or ward boys were mostly
performing the internal waste transportation activities. Some NGOs were found carrying out the
job of biomedical waste segregation, disinfection and collection activities in some private HCFs.
In case of external (e.g. off-site) transportation, all sorts of biomedical wastes were collected from
the municipal dustbins and city skirts and transported to municipal dumping site by City
Corporation or Municipal authority with unprotected open track spreading bad ordour and creating
public nuisance. In tertiary hospitals, only in 27% cases, treatment for infectious and sharp wastes
was found to be done. Only about 11% hospitals were found using ‘incinerator’ for infectious
waste treatment and 10% used needle cutter for ‘cut or breaking’ of sharps and about 16% were
found using disinfection processes in different ways for recyclable wastes before final disposal.
More than half of the hospitals were reported to handle infectious waste in naked hands, about one
third were used to handle infectious wastes using gloves, masks and other protective measures in
special cases and only 18% of the HCFs reported to use gloves and masks always. In case of sharp
equipments, about three fourth of the HCFs were found to have handled it by naked hands, only
one hospital reported using gloves and masks in special cases and only 16% HCFs were found.

Solid waste analysis, open-plate airborne pathogen analysis, and swab analysis from study
hospitals were reported to contain different pathogenic bacteria and fungi. Staphylococcus sp.,
Klebsilla sp., Pseudomonas sp., Proteus sp., E. coli, Fecal coliform, Salmonella sp. were common
pathogenic bacteria found from microbiological analysis of samples collected from healthcare
facilities. These bacteria are responsible for causing pneumonia, meningitis, urinary tract infection,
wound infection, respiratory infection (Klebsilla spp.,proteus), typhoid fever, paratyphoid fever,
gastroenteritis (salmonella spp.), diarrhea (E. coli), sore throat, scarlet fever, rheumatic fever,
impetigo (streptococci spp.),wound infection, ear infection, septicemia (pseudomonas) etc. to
human and responsible for nosocomial infection. There were some harmful fungi like Aspergillus
spp., Penicillium spp. and Mucor spp. found in the collected samples. They have allergic effects
(Severo and Hertz, 1978; Thurston and Cysewsk, 1979; Ford and Friedtman, 1967) of human.
Prevalence of Aspergillus sp., Penicillium sp., Mucor sp. is common in environment and spores of
some species are responsible for allergic infection of human and animals. Aspergillus sp. specially
causes allergic aspergillosis in both man and animal. These patghogenic bacteria can lead to
pathological dysfunction of human body (Ray et. al., 2005; Sigsgaard et. al., 1994). One study
(Akter and Tränkler, 2003) showed the presence of Salmonella spp., shigella spp., Streptococci
spp., coliform, fecal coliform Vibrio spp./ Aeromonas spp. from pathological analysis of hospital
waste sample collected from dustbin near hospitals and dumpsites at Dhaka city. The study found
these pathogens along with Mycobacteria and Amoeba from medical waste collected from disposal
bins and from waste water collected from hospital’s drainage and laboratory basins.

Fig: Talking to a Guard in charge of waste at Raju Hospital (Charabagh, Dhaka).

Guidelines and Medical Waste Management Policies in Bangladesh:
Only about 9% hospitals was found following ‘guidelines’, of which 4.4% was reported to follow
their own guidelines and about 4.5% was found following government guidelines (e.g. manual).
Though there were some manual and training handbooks for the same but due to lack of
government initiatives, those were yet to be implemented to the healthcare facilities. Few
nongovernment hospitals claimed to have their own guidelines but they could not show or submit
any written guideline document. In fact, there is no specific legislation directly related to the
handling, transportation or disposal of medical waste in Bangladesh. In the Environmental
Conservation Act (1995) wastes are classified under Section 2 (1) as “any liquid, solid and
radioactive substance that is discharged, disposed, or dumped which may cause adverse/negative
change to the environment”. All these procedures were very general for all kind of establishments
and not specific for management of medical waste. However, very recently the shortcoming has
been addressed by the Government of Bangladesh through enacting ‘the Medical Waste
Management and Administration Act 2010’ and framing ‘the Medical Waste Management Rules
2010’ to improve the management of waste disposals by government and private hospitals and
clinics (MoF, 2010). Besides, formulation of ‘Solid Waste Management Rules 2010’ is now at
final stage. The existing Bangladesh Environment Conservation Act 1995 describes the powers
entrusted upon the Director General of the Department of Environment. In order to enforce this
Act, the Environment Conservation Rules specify the power and functions of the Department of
Environment and the responsibilities of the industries to ensure conservation of eco-systems. The
rules categories industries and other potentially polluting activities based on their impact and
location and establish procedures for issuing Environmental Clearance Certificates prior to startup
of such activities. Officials of DGHS mentioned that some initiatives were taken for preparing
few documents under the supervision of Director General of Health i.e. manual for medical waste
management in Bangladesh, 2000, Pocket book of medical waste management for Nurses and
Technologists, Research study-1, Strategic plan for Medical Waste Management etc. But most of
them never crossed the hospital boundaries. The Ministry of Environment and Forest drafted the
Hazardous Health Care Waste Management Rules 2003, which were almost similar in structure
and function to that of Bio-medical Waste (Management & Handling Rules), 1998 in India.
However, it was yet to be notified. In this Act, there were provisions of penalizing similar to that
of India. One of the senior doctors from a renowned tertiary hospital stated, “Solid waste
management (which includes solid bio-medical waste) is mostly entrusted on local government
bodies. The responsibility of solid waste collection and disposal lies with the City Corporations
and Municipalities. The City Corporation and Pourashava Ordinance, 1977 is the only local law
that consists some idea for disposal of solid waste management in Bangladesh.”

Fig: Talking to the CEO of Raju Hospital about how they produce these wastes.
Reference:
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SWAN, K.G., 1992, Cost containment in the operating
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MONREAL, J.,1991, Considerations on the Management
of Hospital Wastes in Latin America; Environmental
Health Program, PAHO/WHO.
RAHMAN, M.H.,1996, Hospital Sanitation in Bangladesh;
Proc. of 12th Int. Conf. on Solid Waste Manag. & Secon. Mats., USA.
TIESZEN, M.E. AND GRUENBERG, J.C.,1992, A quantitative,
qualitative and critical assessment of surgical
waste; JAMA,1992, 267.
ULLAH, M.S.,1999, A study on hospital waste management
in Dhaka City; M.Eng. Thesis, Dept. of Civil Eng.,
BUET, Dhaka.
WORLD HEALTH ORGANIZATION (WHO),1983,
Management of wastes from hospitals; World Health
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M. HABIBUR RAHMAN, Professor of Civil Engineering,
BUET, Dhaka, Bangladesh.
S. NOOR-UD-DEEN AHMED, Associate Professor of
Civil Engineering, BUET, Dhaka, Bangladesh.
M. SHEHAB ULLAH, Executive Engineer, Dhaka City
Corporation, Dhaka, Bangladesh.
Learning from this Project:
First and foremost, it's essential to understand the various types of waste generated in hospitals.
Hospital waste can be broadly categorized into three main types: general waste, biomedical waste,
and hazardous waste. General waste includes non-hazardous materials such as paper, cardboard,
and food waste. Biomedical waste comprises potentially infectious materials like blood, body
fluids, used needles, and tissues. Hazardous waste encompasses chemicals, pharmaceuticals, and
other materials that pose a risk to human health or the environment due to their toxic, reactive,
flammable, or corrosive nature. Effective hospital waste management begins with segregation at
the source. Healthcare facilities typically utilize color-coded bins to segregate different types of
waste. Proper segregation ensures that potentially hazardous materials are handled separately from
non-hazardous waste, reducing the risk of contamination and infection transmission. Once waste
has been segregated, it must be appropriately handled and stored. Biomedical and hazardous waste
should be stored in leak-proof containers to prevent spills and cross-contamination. Storage areas
should be secure and inaccessible to unauthorized personnel to minimize the risk of accidents or
intentional misuse. Transportation of hospital waste requires careful planning and adherence to
safety regulations. Dedicated vehicles equipped with appropriate containment systems are used to
transport waste from healthcare facilities to treatment or disposal sites. Transportation routes
should be selected to minimize the risk of spills, accidents, and environmental contamination.
Treatment of biomedical waste is essential to render it safe for disposal. Common treatment
methods include incineration, autoclaving (steam sterilization), and chemical disinfection. These
processes help destroy pathogens and reduce the volume of waste, making it safer and more
manageable for final disposal. Similarly, hazardous waste may undergo specialized treatment
procedures to neutralize or detoxify it before disposal. Chemical treatment, thermal treatment, and
biological treatment are among the techniques used to treat hazardous waste, depending on its
specific characteristics and regulatory requirements. Disposal of hospital waste must comply with
local, national, and international regulations governing waste management. Landfilling,
incineration, and recycling are common disposal methods, with the choice depending on the type
of waste and available infrastructure. Proper disposal prevents environmental pollution, minimizes
public health risks, and ensures compliance with regulatory standards. Training and education are
essential components of effective hospital waste management. Healthcare staff should receive
comprehensive training on waste segregation, handling, transportation, treatment, and disposal
procedures. Regular refresher courses and updates on regulations help ensure that staff members
remain knowledgeable and compliant with best practices. Environmental sustainability is a key
consideration in hospital waste management. Healthcare facilities are increasingly adopting
strategies to reduce waste generation, improve recycling efforts, and minimize the environmental
impact of their operations. Initiatives such as the use of reusable medical devices, green
procurement practices, and energy-efficient technologies contribute to a more sustainable
healthcare system. Hospital waste management is a multifaceted endeavor that requires careful
planning, implementation, and monitoring.
Discussion:
Unhygienic disposal of hospital waste in Dhaka City poses a serious health hazard to the city. The
hospitals require hygienic system approach in handling, storage, transport, treatment, and disposal
of their wastes by the methods that at all stages minimize the risk to public health and to the
environment. Public awareness through mass media, proper hygiene education to the scavengers,
mandatory staff education in waste segregation, and to regulate hospital waste management
systems will change the traditional habits of different group of people involved in this sector. The
waste generation rates in Dhaka city ranges between 0.8 kg/bed/day to 1.67 kg/bed/day and these
include about 15 per cent of hazardous waste. An assessment of cost effectiveness of different
treatment options indicates that the treatment of hazardous waste in a centralized is perhaps the
best treatment option in Dhaka city. Because hospital waste management affects public health,
environmental sustainability, and regulatory compliance, it is an important issue that has to be
thoroughly discussed. Hospital waste must be managed effectively in a number of ways, including
handling, treating, disposing, and transporting of the trash. Hospital waste must be segregated at
the source in order to reduce hazards and guarantee correct management. Healthcare institutions
can lower the risk of contamination or infection transmission by implementing suitable disposal
procedures and classifying garbage into general, biomedical, and hazardous categories.It is crucial
to follow the right handling and storage practices to avoid spills, mishaps, and contamination of
the environment. Healthcare facilities are required to make sure that hazardous and biological
waste are kept in leak-proof containers and that storage places are locked and uninvited
into.Hospital waste transportation needs to be done carefully. Hospital waste transportation
involves meticulous planning and strict attention to safety requirements in order to reduce the
possibility of mishaps and environmental contamination while in transit. Waste is transported to
treatment or disposal facilities by use of specialized trucks fitted with containment
capabilities.Hazardous and biological waste must be treated in order for them to be safely disposed
of. Methods including chemical disinfection, autoclaving, and burning help kill germs and reduce
waste volume, making it easier to dispose of in the end.Hospital waste must be disposed of in
accordance with municipal, federal, and international laws to protect the environment and public
health. Common disposal techniques include incineration, landfilling, and recycling; the option
selected will rely on the kind of trash and the infrastructure that is available.In general,
conversations about hospital waste management ought to focus onHowever, the system has to be
maintained properly with appropriate various control apparatus. Despite the fact that medical
wastes are considered as hazardous, due to their infectious and/or toxic characteristics, little
attention is given to their proper management and disposal. The study conducted at a typical
hospital with a 400–600 bed capacity revealed that the waste management system needs
improvement at every stage of waste handling. Problems were mainly observed because of the
lack of adequate staff training on healthcare waste management issues and on the hazards that
might 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. New facilities should
be established for the complete management of medical waste in Dhaka City.