Introduction

The management of hospital generated waste is not only the responsibility of the hospital administration but also of every department and every healthcare providing personnel in the hospital. It is a process that should begin at the site of a generation where medical waste has to be properly collected as well as segregated from other non-hazardous waste in specific color-coded receptacles. Improper disposal systems result in the reuse of discarded syringes, IV tubes, blood bags and other equipment that is not designed for either sterilization or reuse. There are many government hospitals and private hospitals and clinics situated in Barisal.  For collecting information about hospital waste management in Barisal, the study area was Sher-E-Bangla Medical College Hospital (government hospital).

Hospital Waste

Hospital waste contains infectious material (or material that’s potentially infectious). The 1988 Medical Waste Tracking Act defines is as waste generated during medical research, testing, diagnosis, immunization, or treatment of either human beings or animals. Some examples are culture dishes, glassware, bandages, gloves, discarded sharps like needles or scalpels, swabs, and tissue. Hospital waste is also called medical waste, clinical waste, biomedical waste, healthcare waste, etc.

General information
about Sher-e-Bangla Medical College Hospital (SBMCH)

Sher-e-Bangla Medical College Hospital is a government medical college in Bangladesh, established in 1968. It is located in Barisal. It is affiliated with the University of Dhaka as a constituent college. The college has an area of about 33 ha. Student dormitories, nursing institute, nurses’ training institute, a dormitory for staff nurses, and residences of teachers are situated on the campus. Every day about three thousand patients come to this hospital in the outdoor department to get treatment. The number of beds was 500 before, which now stands at 1000. There are often 1700 to 2000 patients admitted here. The total ward figure is more than 43.

Field observation

Field observation was made at the location on 15 October 2018 at 11 am to see the hospital waste management systems. Waste generation sites (ward, laboratory, kitchen), and waste disposal sites (dustbin, dumping site, drainage system, wastewater flow) were observed. The current waste management system and the safety measures taken in the hospital were also observed.

Interviews

Some interviews with ward master, doctors, nurse and some patients of the medical were taken. Ward master of the medical who are involved in waste management and dispose of systems gave the most important information and his signature at that time was taken.

Findings

From all of the interviews and field observations, the following information about waste management systems in Sher-e-Bangla Medical College Hospital was collected.

  • There are several types of waste generated from the hospital of which discarded blood, sharps, body parts, human/animal tissues, used bandages, discarded gloves, needles, scalpels, etc.
  • There are two large plastic drums in front of all the wards to remove the dirt. One of them is used to put dry dirt on it and another is used for wet dirt. There is no separate dustbin for different types of waste. All types of waste are put together at the same time at an open place. Sharp wastes such as needle, the bottles of injections, blades, etc are not separated and those are not exposed to sterilization before throwing.
  • The waste that put together at the open place is collected by trucks of Barisal City Corporation (BCC) and dispose of these to the landfill site of Barisal.
  • Disinfection, deep burial, open burning, and incineration methods are done in the medical to manage hospital waste. Children and human body parts are buried without dis-infecting. Md Abul Kalam Azad, Ward Master of Sher-e-Bangla Medical College Hospital, said, “there are no enough facilities and treatment methods for hospital waste management. Only incineration, open burning, and deep burial methods are used”
  • Those who are in charge of the cleaning in this hospital do not have any proper training related to cleaning. No training is taken from the hospital in this regard. They have no idea about the side effects of medical waste. They never used gloves, masks, while cleaning.
Figure: The burning system of medical waste and the medical waste storage place. (Photo credit: Nargis Akter Shapna, SES, BU)

Recommendations

Based on the findings of this study, the following recommendations are made to improve medical waste management in Bangladesh (  specially Dhaka and Barisal) :

* Effective and efficient waste segregation systems should be
developed and also implemented.

* Staff training and awareness underpin several of the short and long
term solutions suggested to reduce the waste at the source.

* Hospital waste marked vehicles must be increased.

* Medical waste vehicles should be covered properly to prevent waste from leaking.

* Medical waste should not be mixed with other municipal waste.

* Color code for medical/hospital waste must be followed.

* Government should promulgate and implement laws as well as
regulations regarding medical waste management.

Conclusion

In summary, the results of our case study of Sher-e-Bangla Medical College Hospital suggest that the need for extensive awareness and training for staff with regards to their perception towards the healthcare waste and also in the implications involved in its incorrect handling. Unless there are greater measures put in place and start acting accordingly as recommended in this study the rise in the quantities of healthcare waste and its mishandling will continue unabated and may be of a big concern in the future. Though WHO and the health organizations of all countries have issued clear guidelines for the disposal of the hospital and other medical wastes these guidelines are rarely followed. So to improve hospital waste management systems we are all work hand in hand carefully and properly follow all of the guidelines.

References

  1. https://www.medprodisposal.com/what-is-medical-waste-medical-waste-definition-types-examples-and-more
  2. http://www.bwaste.com/key-methods-of-medical-waste-treatment-and-disposal/
  3. “Medical Waste Disposal in Dhaka City: An Environmental Evaluation”.
  4. hospital waste management issues and steps taken by the government of Pakistan, Oct 2006, jawed Ali khan, director, ministry of environment
  5. https://www.ncbi.nlm.nih.gov/m/pubmed/2549278/
  6. http://www.newagebd.net/article/12994/medical-wastes-on-roads-water-bodies-raise-concerns

Author:
Nargis Akter Shapna
Soil and Environmental Sciences
University of Barishal, Bangladesh

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