Medical Waste

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MEDICAL WASTE MANAGEMENT

Health Facilities in BangladeshAt Union Level -Union Sub centre (USC)-1362 -Health and Family Welfare Centre (HFWC)- 3053 At Upazila Level Upazila Health Complex-460 At District Level - District Hospital-59 At National Level - Government Medical Colleges- 15 - Postgraduate/specialized hospitals-7 Beside these there are about 33 private medical and dental colleges and 1213 registered clinics in and outside Dhaka. The number of diagnostic centers is 1,541 of which 580 are in Dhaka city. The total number of hospital beds is 51, 684 in 2005.

Medical Waste has been defined as all the Solid, Liquid, Gaseous, high pressurized and scrap of Radioactive waste, effluent, by-product, organism or surplus materials which directly or by broken or by worn out or by contaminated or by damaging develop adverse or negative change/effect or risk to human or environment.

Between 75% and 90% of the waste produced by health-care providers is non-risk or general health-care waste, comparable to domestic waste. It comes mostly from the administrative and housekeeping functions of health-care establishments and may also include waste generated during maintenance of health-care premises. The remaining 10-25% of healthcare waste is regarded as hazardous and may create a variety of health risks.

Major sources of health-care waste

Hospitals University hospital General hospital District hospital Other health-care establishments Emergency medical care services Health-care centres and dispensaries Obstetric and maternity clinics Outpatient clinics Dialysis centres First-aid posts and sick bays Long-term health-care establishments and hospices Transfusion centres Military medical services Related laboratories and research centres Medical and biomedical laboratories Biotechnology laboratories and institutions Medical research centres Mortuary and autopsy centres Animal research and testing Blood banks and blood collection services Nursing homes for the elderly

Hazards of Medical Waste

A small amount of hazardous waste may infected the large amount of general waste Organic portion ferments and attracts fly breeding Injuries from sharps to all categories of health care personnel and waste handlers Increase risk of infections to medical, nursing and other hospital staff Injuries from sharps to health workers and waste handlers Poor infection control can lead to nosocomial infections in patients particularly HIV, Hepatitis B & C Increase in risk associated with hazardous chemicals and drugs being handled by persons handling waste Poor waste management encourages unscrupulous persons to recycle disposables and disposed drugs for repacking and reselling Development of resistant strains of microorganisms

Disadvantages of Poor Health Care Waste Management

RISKS TO HEALTH CARE WORKERS AND WASTE HANDLERS

Poor management of health-care waste can cause serious disease to health-care personnel, to waste workers, patients and to the general public. The greatest risk posed by infectious waste are accidental needle stick injuries, which can cause hepatitis B and hepatitis C and HIV infection. There are however numerous other diseases which could be transmitted by contact with infectious healthcare wastes. During the handling of wastes, injuries occur when syringe-needles or other sharps have not been collected in rigid puncture proof containers. Inappropriate design and/or overflow of existing sharps container and moreover unprotected pits increase risk exposure of the health care workers, of waste handlers and of the community at large, to needle stick injuries.

RISK TO THE GENERAL PUBLIC The reuse of infectious syringes represents a major threat to public health. WHO estimated that, in 2000, worldwide, injections undertaken with contaminated syringes caused about 23 million infections of Hepatitis B and Hepatitis C and HIV. Such situations are very likely to happen when health-care waste is dumped on uncontrolled sites where it can be easily accessed by the public: Children are particularly at risk to come in contact with infectious wastes. The contact with toxic chemicals, such as disinfectants may cause accidents when they are accessible to the public. In 2002, the results of a WHO assessment conducted in 22 developing countries showed that the proportion of health care facilities that do not use proper waste disposal methods range from 18% to 64% .

Persons at risk of the hazards of medical waste

Depending on the type of procedures, the persons at risk and mode of transmission in some common medical procedures are: Patient Health worker, Laboratory personnel, Supporting staff, Transport worker

Classification of Medical Waste in Bangladesh

General Waste

Pieces of paper Boxes Container Cork Food wastes; Fish, Meat, Vegetables, fruit coverings Egg shell, coconut shell Non-infectious dressing gauze, plaster

Infectious Waste

Infected clothing, bandage, sponge/swab, plaster, syringe Coagulated Blood/ Plasma Used sanitary pad Dialysis related waste Ryles tube, Gloves, Masks, Airway Tube, Endotracheal Tube, Catheter, Drainage Tube/bag, Blood Transfuse tube /bag, Culture Media (Autoclaved just immidiate to use) Blood collection Syringe Amputed parts of the body/ tumour, tissues, placenta, etc.

Sharp Wastes All types of needles; hypodermic needles, Infusion sets, saws, scalpels; knives; blades; broken glass, and nails

Recyclable Waste Uninfected plastic materials Papers Cardboard Metallic containers Saline set Mineral water bottle

Radioactive waste Radioactive waste includes solid, liquid, and gaseous materials contaminated with radionuclide. Unused X-Machine Head

Liquid Waste Used Water Vomit, Cough Suction fluid Pus, Serum, coagulated Blood Amniotic fluid Liquid chemical Unused medicine Drainage pipe waste water

Uniform Colour CodeGovernment initiative to standardize colour coding of hospital wastes for in-house management. Black for general waste Yellow for infectious waste Red for sharp waste Green for recyclable waste Silver for radioactive waste Blue for liquid waste

Medical waste Management

Proper internal management Safe waste transportation Final Disposal management

Proper internal management

Segregation: Separating different types of waste at the point ofgeneration and keeping them isolated from each other. By doing this, appropriate resource recovery and recycling techniques can be applied to each separate waste stream. The amounts of infectious waste, hazardous waste and low-level radioactive waste that must be treated according to special (and usually costly) requirements are minimized. If not segregated, all hospital waste must be treated as potentially bio-infectious Source Reduction: Minimizing or eliminating the generation of waste at the source itself through techniques such as product substitution, technology change and good operating practices. Resource Recovery and Recycling: Recovery and reuse of materials from the waste stream. The majority of waste from health care facilities is surprisingly similar to that of an office building or hotel -- paper, cardboard and food waste. Hospitals can implement fairly simple programs that divert these materials from the solid waste stream, lowering disposal costs Internal transportation: Internal transportation: Transportation of wastes from its source of generation to central collection/storage section. Central waste disposal: Methods and equipments used to dispose the waste.

Colour Code Black

Types of Waste General Waste

Characteristics of Waste Non-hazardous, noncontaminated, Anatomical, Pathological, infectious, contaminated Contaminated and noncontaminated, Infectious, noninfectious Hazardous, Non-hazardous, Infectious, Non-infectious, Contaminated, Noncontaminated Radioactive

Container Nonpunctured Plastic Bin Nonpunctured Plastic Bin Nonpunctured Plastic Bin, Box Nonpunctured Plastic Bin, Bowl Nonpunctured Lidded Box Nonpunctured Plastic Bin

Yellow

Infectious waste

Red

Sharp Waste

Blue

Liquid Waste

Silver

Radioactive

Green

Recyclable Waste

Non-hazardous, Noninfectious, Non-contaminated

Final Disposal Management

Incineration Autoclaving Deep burial Recycling

Wastes requiring incinerationAnatomical parts and animal carcasses, and Cytotoxic drugs (outdated), toxic laboratory chemicals other than mercury. Patient contaminated non-plastics and non-chlorinated plastics. Waste that cannot be incinerated Chlorinated plastics, volatile toxic wastes such as mercury.

Shredding machine

Hospital Waste Generation

Generation of hospital waste in Bangladesh is 0.78 kg/bed/day. Non-hazardous waste is 0.64 kg/bed/day (82.05%) Infectious waste is 0.11 kg/bed/day (14.10%) Sharp waste is 0.03kg/bed/day (3.85%) World Bank estimates, 36,000 tons of healthcare waste is generated every year in Bangladesh. Out of this amount approximately 7,200 tons may be considered hazardous.

Evidently, Generation of hazardous waste in Specialized Hospitals is more than secondary and tertiary level hospitals

Legal provisions

The Ministry of Health and Family Welfare of Bangladesh formulated the Medical Waste Management Regulations, which is now in the final stage, under The Bangladesh Environment Conservation Act, 1995. In this proposed rule, the responsibilities of medical waste generator has been documented with direction of Internal management (segregation, color coding, packaging, transportation and storage), External transportation, and category wised treatment and disposal methods. In the proposed rule there is also provision of penalty for contravention of