Critical Issues of Present Medical Waste Management Practice in Rajshahi City and its Improvement Strategies

Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 316-323

J. Environ. Treat. Tech.

ISSN: 2309-1185

Journal weblink: http://www.jett.dormaj.com

Critical Issues of Present Medical Waste

Management Practice in Rajshahi City and its

Improvement Strategies

3,1

Md. Niamul Bari , Mir Md. Abdul Hannan , Md. Zahanggir Alam , Md.

Annaduzzaman⁴

Department of Civil Engineering, Rajshahi University of Engineering & Technology, Bangladesh

Health Engineering Department, Ministry of Health and Family welfare, Bangladesh

Civil Engineering Department, Curtin University, Perth, Western Australia-6102

Sanitary Engineering Section, Department of Water Management, CiTG, Delft University of Technology, The Netherlands

Received: 11/05/2019

Accepted: 12/06/2019

Published: 30/12/2019

Abstract

The study was conducted to evaluate medical waste management practices and to determine the critical issues in medical waste

management in Rajshahi City. A survey was conducted to collect information about the practices related to waste segregation,

collection procedures, types of onsite storage containers, onsite handling, processing and storage, primary dumping point, transfer

and transport, treatment of wastes, and final disposal options. This study indicates that the rate of medical waste generation varies

among health care establishment as 336.23 kg/day, 7.14 kg/day, 2.11 kg/day, 3.92 kg/day, 1.21 kg/day and 15.05 kg/day at Rajshahi

Medical College Hospital, Christian Mission Hospital, Al-Madina Clinic, Mohanagar Clinic, Rajshahi Dental College and Popular

Diagnostic Center, respectively. The highest 15 types of wastes are analyzed from wastes generated in Rajshahi medical college

hospital. However, only two to six types of wastes are obtained in other health care facilities. The critical issues identified from

this study are not accumulation of all types of wastes in every hospital, colour containers are not always used by many hospitals,

collection of wastes from source of generation is not properly performed, primary dumping site is not cleaned after transferring

and transporting the waste, there is no incinerator except Rajshahi Medical College Hospital and it is not used regularly, hazardous

wastes are burnt in open place. Rajshahi City Corporation, the waste management authority, has no treatment and disposal facility

for medical wastes. The wastes collected from all health care facilities are dumped by municipal authority along with the municipal

solid wastes by open dumping method. From this study it can be mentioned that there is an urgent need to take immediate action

for raising awareness and education on medical waste management issues. Moreover, trained and skilled medical wastes

management workers are essential in Rajshahi City.

Keywords: Medical waste, Hazardous, management, Critical issues, Improvement

infectious material, sharps, and chemical wastes (Askarian,

Introduction

et al., 2004, Mato and Kaseva, 1999, Henry, et al., 1996).

Various kinds of treatments are applied to the patients such

as surgery, resection of gangrenous organs, biopsy, autopsy,

dialysis, delivery, cobalt therapy, chemotherapy, para

clinical test, injections etc. in hospitals. Various hazardous

and infectious wastes like sharp objects, radioactive wastes

and chemical materials may produce through these treatment

processes (Prüss, et al., 1999).

Medical waste arises from a number of sources

including hospitals, health clinics, nursing homes, medical

research laboratories, dentists, and veterinarians, home

health care, and funeral homes. In Bangladesh like many

The appropriate management of medical waste is

essential due to its infectious and hazardous nature that can

cause risks on environment and public health. The medical

waste management study covers the critical aspects in the

process of Medical waste generation, separation, collection,

transportation, storage, treatment and final disposal.

Improper management of medical waste management can

create many problems especially threats to the health, safety

and environment. Hazardous medical waste can be

extremely dangerous to public health and also environment

even though the waste is small in quantity (Morgan, 1994).

The hazardous medical wastes include pathological and

Corresponding author: Professor Md. Niamul Bari, Department of Civil Engineering, Rajshahi University of Engineering &

Technology, Bangladesh. E-mail: niamulbari@yahoo.com.

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2019, Volume 7, Issue 3, Pages: 316-323

other countries, hazardous and medical wastes are still

handled and disposed together with domestic wastes, thus

creating a great health risk to municipal workers, the public

and the environment. Bangladesh did not compile yet proper

and efficient rule about medical waste management.

Moreover, there is lack authentic information regarding

medical waste management. It is therefore important to

investigate the present medical waste management situation.

People without considering age, sex, race and religion

have to visit frequently to hospitals for their treatment

of wastes, on-site processing and storage, collection, transfer

and transport, treatment and ultimate disposal.

2.1 Selection of Hospital, Clinics and Diagnostic Center

There are more than 40 hospitals and clinics in Rajshahi

City among which Rajshahi Medical College Hospital is a

government hospital and the largest one. In consideration of

establishment age, Christian Mission Hospital is second in

position after Rajshahi Medical College Hospital. Popular

Diagnostic Centre is the largest health care facilities among

the diagnostic centers in Rajshahi City. On the other hand,

there are some medium size and small size hospital and

clinics based on number of beds. Nevertheless, Rajshahi

Dental College is the only dental health care center.

Considering all these matter the following hospitals, clinics

and diagnostic center are selected and listed in Table 1 with

detail information.

(

Rudraswamy, 2013). However, its wastes management

becomes most critical concern in Bangladesh like other

Asian countries. This is because of ignorance of hospital

authority and also wastes management authority. Whereas,

medical wastes management deserves more attention same

as treatment of patients and it should be an essential

component of hospital services, involves technical,

financial, managerial, administrative and logistic support

(

Biswas, 2009). Hospitals are supposed to safeguard the

2.2 Data Collection

health of patients, hospital workers and the whole

community (Mohr, 2006). However, the improper

management of medical wastes may become greater threat

than the original diseases to the patients. It also endangering

the environment and violating human rights to have a

healthy, congenial environment free from any kind of

pollution and contamination.

The rapid increase of hospitals, clinics, diagnostic

laboratories etc. in Rajshahi city exerts a tremendous impact

on human health ecology. It is observed that the solid

medical wastes are being disposed off in the City

Corporation’s collection bins in and around the hospital

premises. The waste is collected by City Corporation’s

vehicles and then transported to the open dumping sites.

Simply disposing it into dustbins, drains, and canals or

finally dumping it to the outskirts of the city poses a serious

public health hazard. However, these wastes may contain

many hazardous components like infectious materials,

human organs, body parts, needles, syringes, used cotton

bandage and other similar items. Low income people collect,

wash and repack for reselling some items from these wastes

to the public and continuing the transmission of diseases

Information regarding the number of beds in different

wards and other related information are collected from

hospital authority. Information about medical waste

management practice i.e. waste generation, on-site collection

and storage system, collection system, transportation,

treatment and disposal are collected by direct field survey.

Wastes generated from different wards of selected health

care facilities are determined for consecutive five days. The

generated wastes are classified in different types by manual

sorting. The rate of generation per bed per day is also

analyzed. The cleaners of the respective health care facilities

are hired for sorting and taking weight of generated wastes.

Electric weight measurement machine is used to take the

weight of waste accurately. The classification of medical

wastes that is followed in this study is shown in Figure 1.

Medical Wastes

Sharps Pathological

Pharmaceutical

Others

(

Hossain and Uddin, 2014). The problem is getting worse

with the increasing number of hospitals, clinics, and

diagnostic laboratories in the city. The improvement of

waste management will have significant long-term impact on

keeping the spread of infectious diseases to a minimum and

result in a cleaner and healthy environment. Therefore, the

aim of this study is to critically observe the present practice

of medical waste management for identifying the critical

issues in every steps of management system and to set

improvement strategies.

Syringes Needle Glass bottle Drug shell Saline

Cotton Blood bag Hand gloves Bandage

Food Paper Cloths

waste

box

Paper

Polythene

Plastic

Methodology

The study has been carried by field investigation through

visual observation, taking exclusive photograph, primary

data collection and secondary data collection in the selected

hospital and clinics. The relevant data for this study were

mainly collected from the published and unpublished

sources. The data were analyzed to address the critical issues

of medical waste management with relation to the generation

Figure 1: Types of waste segregated from different health

care facilities

.3 Data Analysis

Waste generation data is analyzed to determine the total

quantity of medical waste from each selected health care

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2019, Volume 7, Issue 3, Pages: 316-323

facility and rate of generation per beds in each day. The

standard deviation of rate of generation is also calculated to

understand the variation. The fraction of each type of waste

in terms of percentage is calculated.

Table 1: Ward wise daily average generated waste in

RMCH

Generation

rate

No. of Generated

Beds waste (kg)

Name of the Ward

(

gm/bed)

Result and discussion

Orthopediatric Female 30

3.6

3.0

17.6

6.4

5.8

11.2

13.2

4.9

6.9

6.0

4.5

13.4

4.4

11.4

5.4

5.7

5.2

2.6

2.3

10.7

0.6

120.0

100.0

586.6

213.3

193.3

373.3

443.3

163.3

230.0

200.0

281.2

446.6

146.6

380.0

180.0

190.0

130.0

433.3

0.0

It is essential to identify the aspect of mismanagement in

Surgery Male-1

Surgery Female-1

Surgery- 3/4

Surgery-2

Surgery- 3/4

Neuromedicine

Neuro Surgery

Peadiatric Surgery

Peadiatric Medicine

Model Clinic

Gynecology

Medicine-2

Medicine-1

Medicine-4

Medicine-3

Medicine (Student)

Gastro Entarology

Nephrology

medical waste management. However, it could be very

difficult to find out while different facilities and

arrangements for well management system are available in

hospitals or clinics. Apparently it seems to be medical wastes

are managed properly. To perform this difficult assignment,

sequential study has been carried out considering the

functional elements of waste management. The results are

discussed for every selected health care facility following the

functional elements of waste management.

3.1 Waste Generation

The generation of waste varies from hospital to hospital

and even ward to ward of the same hospital based on the

types of hospital and wards as well as activities. The

quantification of generated waste is done on the basis of

wastes collected by cleaners from each ward.

3.1.1 Rajshahi medical college hospital

Rajshahi Medical College Hospital is the largest general

713.3

40.0

hospital and situated at the centre point of the Rajshahi city.

The capacity of the hospital is 1200 Beds. The total no of

doctors, nurses and cleaners are 169, 349, and 137

respectively. The average of five days waste generation and

rate of generation with respect to number of bed are

presented in Table 1.

It is observed from table that total daily average

collected waste by the cleaners is 336.23 kg. The rates of

generation per bed in wards are varying in wide ranges (0 to

Nephrology

Gynaecology-1

Gynaecology-2

Pediatrics Medicine

Eye Male & Female

Pediatrics- NICU

Pediatrics Medicine

Gynaecology-3

Burn-Unit

16.3

7.5

10.8

10.5

16.7

7.6

493.9

250.0

284.2

177.9

835.0

237.5

231.5

294.7

8.8

11.2

835 gm/bed/day). Furthermore, there is no waste produced

Neuro Surgery- Mother

& Child

8.4

336.0

in Casualty wards and minimum waste of 0.22 kg/day is

produce in general ward number 35 (Radiotherapy). The

zero waste production is not the real situation because there

are some activities in every ward. It might be that produced

waste in this ward is not accumulated and otherwise disposed

of. It could not be observed any direct relation between

number of bed and waste generation rate. Furthermore, the

average rate of generation of total wastes per bed is 280.20

gm/bed/day which are very small quantity. It could due to

categories of wards and its function as well as due to the

unauthorized disposal of wastes by patients and their

attendants. The composition analysis and the percentage of

major component of wastes generated in RMCH are shown

in Table 2. Table 2 shows that the highest fraction of waste

is general type which is about 46% of the total waste

followed by about 24% pharmaceutical, 21% pathological

and 9% sharps. Among the different types of waste food

waste generation is the highest amount of 100.44 kg/day and

second highest is blood bag of 41.72 kg/day. The important

matter is that it is very difficult to quantify the total amount

of generated wastes. During the field investigation it is found

that different types of wastes are thrown in various places in

and around the hospital.

Orthopeadiatric Male

Cardiology

ENT

Radiotherapy

Medicine-2 Female

Medicine- 3/4 Female 14

Causality

Cabin

Prison

Ward 42-57

I.C.U & H.D.U

3.5

12.8

0.9

6.4

0.2

10.3

2.1

2.0

0.0

12.5

6.7

5.0

2.3

1.5

12.4

15.0

116.6

457.1

40.9

426.6

13.3

343.3

150.0

142.8

0.0

156.2

0.0

714.2

63.8

62.5

0.0

PO- old, New & I.C.U 36

OCC & I.D

GOT

MOT

0.0

Figure 1 shows some real scenario of medical wastes

thrown in the surrounding places. In these illegal dumps,

there are some hazardous wastes are also observed.

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2019, Volume 7, Issue 3, Pages: 316-323

Table 2: Rate of generation of different components of

waste in RMCH

nurses and cleaners are 3, 10, and 2, respectively. The

average number of inpatients and outpatients per day are 5-

10 and 1-5. Total amount of waste generated is 2.11 kg/day

and mostly are Saline bottle, Saline bag, Saline set, Injection

ampoule and Blood bottle (Table 3). Unlike Christian

Mission Hospital other wastes are not found.

Generation

Compositi

Types of wastes

Sharps

rate (kg/day) on (%)

19.26±5.13 5.73

10.91±3.88 3.24

Syringe

Needle

Cotton

Blood Bag

Hand Gloves 8.74±3.28

Bandage

6.14±2.90

41.72±33.32 12.41

2.52

15.64±5.76 4.65

Glass Bottle 39.90±10.63 11.87

1.82

Table 3: Percentage of Waste Generated from other

Selected Hospitals and Clinics

Pathological

Health care

establishment

Generation Fraction

Type of wastes

rate (kg/day)

(%)

Saline packet

1.50

Pharmaceutical Drug Shell

11.61±6.53 3.45

29.34±18.55 8.73

10.08±6.43 3.00

11.40±3.92 3.40

Saline

Paper

Plastics

Saline set

0.71

0.46

0.82

1.18

2.46

Injection ampoule

Syringes with needles

N.G tube

6.5

Christian

Mission

Hospital

Polythene

Food Waste 100.44±20.4 29.90

Cloths

Paper Box

Total

9.81±7.58

2.92

11.5

16.5

34.5

General

7.00±3.55

2.10

14.33±5.16 4.26

336.23

Catheter

Total wastes generation

rate

.14

Saline bottle

Saline bag

0.50

0.53

0.31

0.50

0.26

23.73

25.08

14.92

23.73

12.54

Injection ampoule

Saline set

Al- Madina

Clinic

Blood bottle

Total wastes generation

rate

.11

Saline bags

Injection syringes

Bottles

0.67

0.64

0.50

1.47

0.64

7.12

6.21

2.75

7.52

6.39

Mohanagar

Clinic

Goj and cotton

Gloves

Total wastes generation

rate

.92

Injection syringes

Saline bottle

0.61

0.60

50.30

49.70

Figure 1: Wastes thrown at unauthorized place in RMCH

Rajshahi

Dental

College

.1.2 Christian mission hospital

Christian mission hospital is guided by Christian

Total wastes generation

rate

.21

Organization. The capacity of the hospital is 30 beds. The

total no of doctors, nurses and cleaners are 10, 20, and 4

respectively. The average number of inpatients and

outpatients per day are 20-25 and 15-20, respectively. Total

amount of waste generated is 7.14 kg/day of which amount

of hazardous waste (sharps and infectious) is 4.46 kg/day

Plain tube

5.07

1.11

33.70

7.36

EDTA tube

Popular

Diagnostic

Centre

Urine sample pot

4.57

30.37

28.57

Glass plate and ESR

tube

Total wastes generation

rate

.30

(

Table 3). The collected waste components are Saline

5.05

packet, Saline set, Injection ampoule, Syringes with needles,

N.G tube and Catheter. It is observed that only some specific

wastes are produced. It means that other types of wastes are

not kept in container and swept away to somewhere else.

3.1.4 Mohanagar clinic

Mohanagar clinic is also

a private health care

establishment which is mainly popular for its surgical

treatment. The capacity of the hospital is 12 beds. The total

no of doctors, nurses and cleaners are 5, 9 and 3,

respectively. The average number of inpatients and

.1.3 Al-Madina clinic

Al-Madina Clinic is a private and a small clinic. The

capacity of the hospital is 15 beds. The total no of doctors,

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2019, Volume 7, Issue 3, Pages: 316-323

outpatients per day are 10-15 and 6-10. Total amount of

waste generated is 3.92 kg/day of which amount of

hazardous waste is 2.61 kg/day. The amount of waste is very

small compared to actual generation. Other wastes are not

kept in container. Therefore, total generated wastes are not

obtained.

points. Some medical wastes are also accumulated into the

internal drain of hospital.

.1.5 Rajshahi dental college

Rajshahi dental college is a dental unit of Rajshahi

Medical College Hospital. Total amount of waste generated

in this hospital is 1.21 kg/day (Table 3). Only injection

syringe and saline bottle are found (Figure 8). It is obvious

that where some people will live and activities are involved

definitely some wastes will produce. It might be that other

wastes are not kept in bin and swept away to somewhere else.

(

.1.6 Popular diagnostic center

Popular diagnostic center is one of the largest diagnostic

centres in Rajshahi city having latest technology. Total

amount of waste generated is 15 kg/day. The generated

components of wastes are Plain tube, EDTA tube, Urine

sample pot and Glass plate and ESR tube.

3.2 On-Site Processing and Storage

Through the field investigation it is observed that on-site

(

(c)

processing and storage activities are not proper in RMCH.

Although there are some colour coded waste storage

containers in some places provided by Health Department

Figure 2: Improper on-site storage of medical wastes: (a) Colour

coded containers are not in use, (b) Using plastic bucket, (c) Some

saleable wastes are picking by scavenger

(

Figure 2a) for different types of waste, these are not used

properly to put into designated waste. Many hazardous

wastes like syringe, medicine cells etc are thrown at outside

the hospital without keeping in designated containers and

waste pickers collect the saleable components (Figure 2b).

Waste pickers collect some saleable portion of medical

wastes to sale in waste material shop. It was found that

reusable or recyclable materials are syringes, plastic bags and

bottles, urine bags, plastics accessories, glass bottles, glass

accessories, polythene, metal, rubber and paper. Other

hospital, clinic or diagnostic centers are also use some kind of

container (plastic bucket) for storing different types of wastes

specially sharps and infectious wastes (Table 2c). The

standard container for medical wastes storage is of55 gal drum

with lid. According to WHO standard, the minimum thickness

of infectious waste bag is 70 m (ISO 7765 2004). But the

facilities and management are not up to the mark. It is seen in

Figure 3c that plastic buckets are used for keeping hazardous

wastes but some wastes are already put down.

The situations for other health care establishment are

more ruthless than RMCH. Christian mission hospital, Al-

Madina Clinic, Mohanaga clinic, Rajshahi dental college and

popular diagnostic center do not have any designated

primary wastes accumulation point or establishment. They

usually throw their wastes directly to the municipal

secondary waste dumping point or handover to municipal

wastes collection workers. However, most of the saleable

wastes such as saline bag, saline bottle, saline set, syringe,

glass bottle etc are taken by cleaning workers and sold them

to the wastes material buyers. This activity is dangerous for

the environment as well as public health.

.4 Transfer and Transport

While primary dumping is done from each and every

ward of the RMCH then City Corporation’s waste transport

vehicle comes at the primary wastes dumping point.

Conservancy workers also collect wastes from illegal

dumping points in irregular intervals. The wastes are

transferred to the transport vehicle and then transported to

the final disposal site. The operation is not provided every

day and does not follow any particular frequency. Figure 4

shows the wastes transfer operation by the City Corporation

workers. One more problem is that they only pick the wastes

from primary accumulation place but not clean the

surrounding place after transferring. As a result the

surrounding place remains dirty and spreads liter at the

nearby places. Other health care establishments do not have

any primary dumping point. Therefore, there is not transfer

operation in these health care establishments. They either

throw the wastes at municipal wastes accumulation points or

directly hands over to the waste collection workers.

.3 Collection

Collection of waste means the picking of waste from on-

site storage point and carry it to some point from where waste

to be transported to the treatment plant or processing station or

disposal site. Usually, Rajshahi Medical College Hospital

workers collect wastes from different wards and designated

place and carried either to the incinerator or municipal waste

accumulation points. Figure 3(a) shows the wastes carrying to

the municipal waste accumulation points. However, all wastes

are not dumped in primary dumping point. Many backward

places are used as illegal dumping point within the hospital

compound. Figure 3(b) shows such illegal two dumping

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2019, Volume 7, Issue 3, Pages: 316-323

processing facilities for municipal wastes and even for

medical wastes. They disposed of all types of wastes

following open dumping method. The disposal of medical

wastes along with the municipal waste is a threat to the

surrounding environment as well as public health.

(

(b)

(

(b)

(

Figure 5: Incinerator in RMCH: (a) Supposed to use for incineration

of hazardous medical wastes, (b) Open burning place of hazardous

medical wastes.

Figure 3: Medical wastes collection scenario: (a) Waste carrying

waste to the primary dumping point inside RMCH, (b) Illegal

dumping of medical waste, (c) Wastes accumulated in internal drain

3.7 Observed Critical Issues

The issues on which more attention must be paid to improve

the present medical wastes management practice is the major

attempt of this study. Following issues are identified as

critical for present medical wastes management practice in

Rajshahi city through an extensive field investigation.

.7.1 Generation

Generated wastes in health care establishment are not

properly handled at the point of generation. Major portion of

the generated wastes are thrown at road side, drain,

municipal waste bin etc. All types of wastes are not kept in

storage container for collection, treatment and disposal. As a

result the quantity of official generated wastes is very less

compared to the actual quantity and few types of wastes are

obtained in some clinics and hospitals.

Figure 4: Waste collection crew of RCC transferring waste to

transport vehicle

.5 Treatment

All infectious wastes are needed to be incinerated for the safe

disposal and to protect the spread of diseases. Rajshahi

medical college hospital has an incinerator for this purpose.

The hazardous wastes include blood, sharps, malignant

organ and human body parts from Operation Theater are

separated from other medical wastes and incinerated inside

the RMCH in an incinerator (Figure 5a). The medical waste

management workers claimed that incineration is done twice

a week but not every day. The incinerated residue is then

dumped into the primary waste disposal point and finally

disposed of by municipal authority. However, it is evident

from the field investigation that there is a doubt about the

running of incinerator because many wastes are carelessly

thrown at surrounding of the incinerator. Sometimes wastes

are disposed of just besides the incinerator and also burn

some wastes here openly (Figure 5b). In this case question

arising that what is happening for the hazardous wastes

produced in other days. There are many treatment methods

for Medical waste as per WHO guideline. Medical wastes

include general waste and hazardous waste from health care

facilities. The general wastes are not treated any more. Other

than RMCH there is no scope of treatment of medical wastes.

3.7.2 On-site handling, Processing and Storage

All generated wastes are not sorted at sources and kept into

designated waste containers. In some health care

establishment, different coloured pales or buckets without

any lid are used for sharps and infectious wastes. As a result,

wastes spread at surrounding places. However, the

department of health supplied colour coded containers for

on-site waste storage but containers are piled at somewhere

else without using.

3.7.3 Collection

There is no trained waste management worker in any

selected health care establishment. The workers either do not

have or use any safety wares like gumboot, hand gloves,

musk, apron, and so one. Most of the health care

establishments collect wastes everyday but not all types of

generated wastes. The waste workers are not aware of

mismanagement of Medical wastes.

.6 Disposal

3.7.4 Transfer and Transport

All Medical wastes generated in Rajshahi City are

Accumulated wastes are transferred from primary

dumping site to the transport vehicle at Rajshahi Medical

College Hospital only. During the transferring of wastes

surrounding areas are not cleaned properly. The wheels and

disposed of by conservancy department of Rajshahi City

Corporation along with the other municipal solid wastes.

City corporation authority does not have any treatment or

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Journal of Environmental Treatment Techniques

2019, Volume 7, Issue 3, Pages: 316-323

body of the wastes transport vehicles are not washed or

cleaned before entering the road from the primary waste

dumping site or from final wastes dumping site though the

waste. A monitoring cell should be formed at every health

care facility to ensure the storing of different types of waste

in designated containers.

vehicle is covered with polyethylene cloth. As

consequence, wastes carrying roads and surrounding area are

3.8.3 Collection

polluting by littering.

Wastes must be collected at regular interval based on

types of waste. Wastes must be put into a designated primary

accumulation bin or house of any similar facilities. Storage

facilities should be cleaned and disinfected in conformity

with WHO medical waste management Code of Practice to

reduce possibility of risks after every emptying. The

surrounding area of on-site storage point must be cleaned

every day.

.7.5 Treatment

There is no waste treatment facility in Rajshahi city

except an old incinerator at RMCH and does not run every

day. The hazardous wastes generated at different health care

establishments are not brought to the RMCH incinerator for

incinerator. It is due to the lack of workers, facilities as well

as coordination among the government and non-government

health care establishments.

3.8.4 Transportation

Medical waste should be transported in suitable

dedicated transport facilities with leak proof containers

which are clearly marked BIO HARZARD. Medical waste

which is subject to transportation for off-site incineration is

packed and labeled in conformity with the requirements of

Bangladesh Medical Waste Management Code of Practice

and generally accepted and recognized international

standards for easy identification and urgent incineration.

Fixed schedule for off-site transportation of medical waste

should be defined, thus reducing the complexity of medical

waste management.

.7.6 Disposal

All most entire wastes generated in Rajshahi city from

different health care establishments are disposed of without

any treatment or taking any special care to the municipal

waste dumping site. The medical wastes are dumped by open

dumping method. Therefore, surrounding environment and

public health are in danger.

3.8 Improvement Strategy

The current practice of medical waste management in

Rajshahi City proved through the study that it has so many

critical issues in every steps of management. Based on the

findings of this study, medical waste management practice is

needed to improve. To achieve this improvement of medical

waste management some aspects are proposed.

3.8.5 Treatment

Possible resource recovery can be performed with

appropriate treatment and disinfection. Storage shelves to

keep medical waste before incineration should be erected in

the storage room at the incineration plant, to avoid putting

the medical waste on the floor. It should be checked properly

that the waste has been appropriately treated and disposed of

in order to minimize risks to human health and environment.

In any circumstances open burning must be protected.

Private companies might come forward to medical waste

treatment. Government should give license to own

incinerators so that they can treat medical waste they collect.

Private health care facilities should make memorandum with

the RMCH to send their medical wastes for incineration.

Residuals/ash should be regularly tested for harmful

substances that could affect human health and the

environment and disposed appropriately.

.8.1 Generation

A set of trained medical waste management workers

should be employed in every health care facility. The

hospital should have weighing facilities so as to have

quantified statistics of medical waste generated. This will

assist them in making informed decisions regarding medical

waste generated and disposed of. Documents of medical

waste generation and waste management practices in the

hospital should be maintained and updated.

.8.2 On-site handling, Processing and Storage

Colour coded and labeled on-site waste storage container

with proper design according to Bangladesh Medical Waste

Management Code of practice or WHO standard code of

Practice should be used consistently in the hospital.

Adequate numbers of on-site storage container should be

placed at suitable locations within wards, corridor, staircase,

kitchen, Operation Theater, pathological sampling points,

and any other relevant work place. Proper instructions

regarding waste handling, separation at source and keeping

in designated container should be posted at the on-site

storage locations.

Periodic training should be provided to healthcare

workers and anyone who involved in the medical waste

management process regarding appropriate segregation

practices. The medical authority should ensure that adequate

protective clothing is available and waste handlers wear full

protective clothing or safety wares like gumboot, hand

gloves, musk, apron etc at all times when handling medical

3.8.6 Disposal

Only the nonhazardous wastes produced in health care

facilities should be disposed of along with the municipal

solid waste. Local government authority must follow the

scientific sanitary approach for disposal of wastes.

3.8.7 Training and Education

Staff at all levels should be continually trained on

medical waste management issues to ensure awareness

according to WHO guideline. The medical waste

management concern parties should periodically evaluate

the effectiveness of training and education programs. The

medical waste management authority should develop

training modules in both English and Bengali on medical

waste management procedures for all health personnel at

different levels. Clinics and health posts should have

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2019, Volume 7, Issue 3, Pages: 316-323

Infection Control Team/committees which include

environmental health experts and waste management

experts. This will improve the ability and effectiveness of the

Infection Control Team to carry out its operations.

Information with respect to risks involved in healthcare

waste management practices have to be disseminated to the

public or general community.

3. Henry G and Heinke G.W., Environmental Science and

Engineering, 2nd Edition. 1996, Englewood, NJ: Pretence-Hall.

Hossain M. L, Uddin M. J, Medical Waste Management at

Upazila Level in Bangladesh. Journal of Environmental

Treatment Techniques, 2014. 2(3): P. 85-94.

Mato RRAM and Kaseva ME., Critical review of industrial and

medical waste practices in Dares Salaam City. Resources,

Conservation and Recycling, 1999. 25: p. 271–287.

Mohr J., Health workers: a global profile, The World Health

Report, WHO, 2006.

Morgan, Current legislation governing Medical waste disposal;

Journal of Hospital Infection, 1994. 30(1), p. 521 – 530.

Pruss A, Giroult E and Rushbrook D., Safe Management of

Wastes from Health-care Activities. World Health

Organization: Geneva, 1999

.8.8 Overall

Medical waste management concern parties should

develop strategic plans for dealing with management of

medical waste issues, which include performance indicators

in order to address health and environmental risks. It is time

to upgrade the Current Medical Waste Management Code of

Practice, Medical waste Management Plan and Waste

Management Act in order to meet the current international

standards on medical waste management. Government

should conduct spot checks to ascertain compliance of

medical waste management to local and international laws

and to ensure environmentally sound principles are adhered

to. The Government should use mass media in sensitizing the

general public and raising their awareness level on

environmental risks associated with improper management

of medical waste. Healthcare facilities should manage risks

so as to protect human health and environmental risks

associated with inappropriate management of medical waste.

Rudraswamy S, Sampath N, Doggalli N, (2013). Global

Scenario of Medical waste Management. ISSN 2277–386X.

Conclusion

Medical waste poses a great impact on human health and

environment. It is utmost important to identify the critical

issues where it needs to pay special attention for preparing

the improvement strategy. The critical issues at every steps

of medical waste management in Rajshahi City are identified

through this study. Proper waste management strategy is

needed to ensure health and environmental safety. There is

lack of proper technical support from the local government

authority in this sector and needs more investment. Practice

of proper medical waste management is also inadequate. It

is seen from the study that there is a lack of man power,

technical knowledge and investment for waste management

in the hospital. It can be said that there is an urgent need for

raising awareness and education on medical waste

management issues. At a regular interval training and

workshop should be arranged to increase awareness and skill

of the hospital authority and waste managing workers.

Medical waste management system should be designed

based on local conditions, resources and facilities.

Implementation strategy should also be set for proper

management. Government must take care of proper medical

waste management through the local government agency or

private sectors. Finally, it could be concluded that immediate

action is needed to be taken to overcome the critical issues

identified through this study.

References

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Biswas, Medical Waste-management Practices in the Hospitals

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