Medical Waste
Ignored field of environmental management
Careless disposal of medical waste is an environmental problem and health hazard.
One estimate shows that some 5.2 million people (including 4 million children) die each year from waste-related diseases all over the world. Thousands of tons of waste are generated everyday in our country. These include household waste, industrial waste and medical waste among many others. Household waste can be handled easily as this is less dangerous to public health and easily recyclable. But things are different for Medical Waste (MW). Medical waste is defined as any solid or liquid waste that is generated in the diagnosis, treatment or immunisation of human beings or animals, in research pertaining thereto, or in the production or testing of biologicals. Although majority of the MW is no more dangerous than household/municipal waste, the hazardous waste, if exposed to the people or environment in an untreated form, would pose various kinds of danger. MW contains both general waste (app. 75-80 per cent) and infectious wastes (app. 20-25 per cent). According to Environmental Assessment and Action Plan For Health, Population and Nutrition Sector Development Program of Ministry of Health and Family Welfare 2011 about 89,945 kgs of MW is generated everyday, out of that about 22,486 kgs are infectious. Another estimation shows that about 36,000 tons of medical waste is generated every year in Bangladesh, out of this approximately 7,200 tons are hazardous Lack of awareness, appropriate policy and laws, and apathy are responsible for improper management of medical waste in our country. The process of collection, segregation and disposal of medical waste is not performed according to recommended standards, and concerned people are exposed to the danger of such waste. Safe disposal of medical waste is essential and is handled in a very professional way in many countries. The impacts associated with improper Medical Waste Management (MWM) can affect public heath directly and indirectly. It can cause HIV and hepatitis infection, among many other diseases. In most of Bangladesh, including its capital Dhaka, traditional and out-dated systems of waste management in health facilities is practiced and improper waste disposal leads to pollution of the environment and creates health hazards. It was, and still is, a common practice of Health Care Establishments (HCE) to dispose their waste into ordinary dustbins without any hesitation. As found in a field survey of 2005, only few, about five, private HCE of Dhaka used to collect their waste systematically, they used to segregate sharp and infectious waste and send them to International Centre for Diarrhoeal Disease and Research in Bangladesh (ICDDR,B) for incineration at a rate of Tk 70/kg. In the legal side of MWM issue, there was no formal legislation before 2004 except a manual compiled by the Directorate General of Health Services, Ministry of Health and Family Welfare in 2001. In 2004, the Ministry of Health developed a guide book named Hospital Waste Management Pocket Book for the nurse, medical thechnologist, ward master and other related staffs. But it has not been updated till today, with the changing technology in medical service and also changing strategy in the MWM world wide. In 2008, Medical Waste (Management and Processing) Rule 2008 was promulgated by the government. This Rule was prepared by Department of Environment (DoE) through the participation of Ministry of Health and Family Welfare (MOHFW), Ministry of Law(MOL) and Ministry of Environment and Forest (MOEF) for processing and management of medical waste in Bangladesh. Though the training for improved MWM was started in 2005, it was not of much significance as there was lack in the perception of the importance of MWM. National Implementation Coordination Committee (NICC) was formed by MOHFW in 2007 for MWM, but it was not of significance as there was no legislative arrangement to base its implementation strategy. Though DCC is working with Project in Agriculture, Rural Industries, Science and Medicine (PRISM) under MOHFW it has no legal basis of its own. DCC has outsourced the management of medical waste to PRISM Bangladesh. But the problem is PRISM Bangladesh does not have resources, neither has got any assistance from any source. * Although the MWM system has developed it does not mean that no further development is possible. To further improve MWM system, we have to consider the following * Raise awareness in common people and educate and train the medical staffs about medical waste issues * Proper waste management strategy is needed to ensure health and environmental safety from medical waste * Segregation of medical waste should be done at the point of generation. Different colored bags should be used for collection of hazardous and non-hazardous waste * Safety measure must be taken in handling hazardous waste. Gloves, masks aprons, etc. must be used during handling of medical waste * Hazardous medical waste may be collected from different hospitals and treated centrally. Methods of treatment should be selected carefully * For the proper management of MW new and new incineration centers may be established. * The existing medical waste management system currently serves a limited number of HCE. New facilities should be established in different parts of the country and the existing facility should be expanded Above all, government should promulgate and implement laws and regulations regarding medical waste management. It has to take the whole responsibility for the proper disposal. Disposal of medical waste is a growing environmental problem in Bangladesh. Until recently, the management of medical waste has received little attention. It is evident that most of the health care institutions do not segregate their generated waste and 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 acceptance of single-use disposable items. Efforts have to be made for minimisation and recycling of some medical waste prior to final disposal, if not infected or contaminated.
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