A short note on Hospital Waste Management for the Public Health students at Post Graduation Level

1. Brig Gen Dr Zulfiquer Ahmed Amin
M Phil, MPH, PGD (Health Economics), Advance Course HA (AIIMS, Delhi), MBBS
North South University (NSU)

2. Since beginning, the hospitals are known for the treatment of sick
persons but we are unaware about the adverse effects of the
garbage and filth generated by them on human body and
environment. Now it is a well established fact that hospital waste is a
potential health hazard to the health care workers, public and flora
& fauna of the area.

3. Everything is made for a defined purpose. Anything which is not
intended further use, termed as waste.
Any waste generated as a consequence of healthcare delivery, out of
hospital activities, can be termed as ‘Hospital Waste’ (HW). It is also
called Bio-Medical Waste (BMW).

4. Hospital Waste Management means the management of waste
produced by hospitals using such techniques that will help to check
the spread of diseases through the waste.
Rate of generation of HW:
Developing Countries: 1-2 kg/patient/day
Developed Countries: 1-5 kg/patient/day

5. • Hospitals
• Nursing homes
• Clinics
• Medical laboratories
• Blood banks
• Mortuaries
• Medical research & training centers
• Biotechnology institution/production units
• Animal houses etc.
• Patients’ home, when patient is managed at home.

6. Estimated Medical Waste Generation in some countries of Asia

7. Medical Waste Generated by Different Countries
Environmental Performance Index (EPI) 2020 measures level of environmental pollution,
including hospital waste management by 180 countries. India ranked 168th and Bangladesh
177th in 2022.

8. Classification of Hospital Waste:
Hazardous:
Non-Hazardous:

13. Sources of Hospital Waste

14. Average Food Waste in a Hospital

15. Impact of Hospital Waste
1. Infection:
Bacterial origin e.g. tetanus, anthrax, cholera, diarrhoea; fungal
infections e.g. candida, cryptococcus; viral infection e.g. hepatitis,
poliomyelitis.
2. Genotoxicity and Cytotoxicity:
In genetics, genotoxicity describes the property of chemical agents
that damages the genetic information within a cell causing mutations,
which may lead to cancer. Cytotoxicity is the quality of being toxic to
cells.

16. 3. Chemical Toxicity:
Like benzene, carbon tetrachloride pose risk to workers handling
them.
4. Radioactive Hazards:
Causing cancerous growths, genetic problems.
5. Physical Injuries:
Injuries and accidental cuts due to handling of sharps and needles.
6. Underground and surface water pollution. Mass scale spread of
Cholera, Typhoid, Hepatitis-A, diarrhoea, dysentery, poio etc
7. Public Sensitivity:
Loss of aesthetic view, fowl smelling.

18. Management of Healthcare Waste
• National Policy, Strategy, Plan, Guidelines and SOP
• Legislation/ Rules for waste management
• Political commitment
• Committed manpower
• Good management and supervision
• Proper budgetary allocation
• Community participation
• Local and appropriate technology
• Involvement of NGOs
• Development of Information System in relation to BMW
Effective Waste Management needs:

20. Preferred Options of Waste Management

21. Hospital Waste Management Process

22. WHO Hospital Waste Management Cycle

23. Waste Minimization
Waste minimization is characterized as the reduction of waste from
the source of origin and the reuse and recycle of the waste.
The basic components of waste minimization are:
• Improved housekeeping;
• Change in process technology;
• Change in products,
• Change in input materials;
• Reuse the material after proper disinfection
• Recycling of chemical and raw materials;
• Recovery of by-products.

25. Waste Identification
Waste Identification means to determine the nature and property of
the waste; if it is solid or liquid, hazardous or non-hazardous, toxic or
non-toxic etc.

26. Waste Segregation
-Waste segregation means dividing or separating waste at earliest
opportunity, at point of origin.
-Hazardous waste not to mix-up with non-hazardous waste.
-An appropriate way of segregating the waste is by sorting the
waste into different colour code.
-Colour code is easy for identification and thereby easy for safe
handling, transportation, and waste treatment.
-Colour code varies from country to country and even from one
hospital to another in the same country.
-If segregation is not properly done, small quantity of hazardous
waste mixes with large volume of non-hazardous waste, making a
large volume of hazardous waste; costly to dispose and increase
health hazards.

27. WHO Recommended Colour Code

28. Colour Code Practice in CMHs

29. Waste Handling
Waste Handling means waste collection from the designated colourd
bins, storage and transportation by designated individuals.
Out-Fit of Waste-Handler

30. Waste Collection
-Collector must wear PPE (Personal Protective Equipment).
-Collection of waste only in designated coloured bag or covered
coloured bins.
-Content of the container should not exceed ¾ of its capacity.
-If bag is used for collection, neck of bag should be strongly tied.
-Avoid throwing, dragging over floor or holding the bottom of the
container.

31. -No container should be used if damaged, or licked.
-All bins should be covered with lid during collection and
transportation of waste.
-No container should be transported without leveling ‘hazard
warning’.
-During collection, each container should be replaced with new one.
-Collection of sharp medical waste under maximum precaution.
-If there is spillage of waste from the container, gently collect the
waste into bin, soak the area with 2% Lysol solution, wait for 30
minutes, then wash and wipe.

32. Placement of Colour Bins
-Appropriate container should be placed at all important location
where particular wastes are generated.
-Instruction on waste identification should be pasted over the
containers.
-Waste containers should be labeled with some basic information
about category of waste, weight of the material, date of collection,
and site of waste production (In irremovable or water resistant ink).
-General Waste (Black Bin) could be placed at landing area of the
staircase, in the straight long corridor bin could be placed at 50
meter distance, yellow coloured bin could be placed outside of the
toilet in female ward for collection of sanitary napkins.

33. Transportation
In-house transportation
In-house transportation means transportation of waste from the site
of origin or collection to temporary storage area within the
institution.
Waste should be transported by designated trolley, through the
designated route according to time schedule given by the institutional
authority.

34. Temporary in-house storage
The store will be a room or area or building within the healthcare facility
depending upon the quantity and quality of waste production and
frequency of waste collection.
Characteristics of In-House Storage
-Waste should not be stored more than 24 hours.
-Prevent access of unauthorized person.
-Easy access for workers and collection vehicles.
-Away from food preparation, processing, and food store.
-Sufficient light and water supply.
-Inaccessible for scavengers, animals and rodents.
-Away from water sources.

35. Record Keeping
Accurate record keeping is needed for effective medical waste
management. Record keeping might give some important information,
which will help:
-To assess the quality and quantity of generated waste.
-To assess the cost directly related with the man and materials.
-To assess the cost related with waste treatment and disposal method.
-To assess the recurrent expenditure.
-To assess the risk involved with generated waste, amount and nature
of accident, amount of damage, measures taken for accidents etc.
-To assess the failure, problems and obstacle in waste management for
better compliance of the program.

37. Treatment and Final Disposal of
Hospital Waste
Treatment of Waste:
-Incineration: Burning at high temp with O2
.
-Autoclave: Sterilization of microbiological waste by subjecting them
to high pressure (15 psi), high temperature (1210C) in moisture for
around 30-60 minutes.
-Chemical Disinfection:
-Render Inert: Neutralizing waste by radioactive chemicals.
Incineration
Incineration involves burning waste at high temperatures
ranging between 750°C and 1100°C in the presence of oxygen. This
method is capable of reducing waste mass by almost 70% and volume
by up to 90% and produce heat and energy.

38. Incineration
Characteristics of waste suitable for incineration are:
-Content of combustible matter above 60%.
-Content of non combustible matter below 50%.
-Moisture content below 30%.
-Higher heating value of waste (Average 5100 BTU/Lb of waste).
Waste types not to be incinerated are:
-Pressurized gas containers.
-Large amount of reactive chemical wastes.
-Silver salts and photographic or radiographic wastes.
-Halogenated plastics such as PVC.
-Waste with high mercury or cadmium content such as broken
thermometers, used batteries.
-Sealed ampoules or ampoules containing heavy metals.

39. Chemical Disinfection
-Disposal of chemical waste is the responsibility of the unit
generating/using it.
-Chemicals should be neutralized by disinfectants and then drained
into the sewerage system.
-Liquid chlorine, sodium hypochlorite, chlorine dioxide, ozone,
phenolic compounds, iodine and iodine compounds are commonly
used as chemical disinfectants

40. F/b = Followed By

41. (Effluent Treatment Plant)

42. There are only three NGOs in Bangladesh that are actively working in
the field of hospital waste management. These NGOs are ‘PRISM’
(Project in Agriculture, Rural Industry, Science and Medicine)
Bangladesh in Dhaka city, ‘BASA’ (Bangladesh Association for Social
Advancement) in Tongi and ‘Shawpno’ in Bagura. They are collecting
the waste from the designated hospitals with a nominal service
charge. Among the three NGOs, PRISM Bangladesh along with DCCs
(Dhaka City Corporation) are collecting and treating the hospital
waste up to final disposal. There are only 1121 hospitals, clinics and
diagnostic centres under PRISM management program. Recently,
PRISM has expanded their program in Narayanganj, Savar, Sylhet,
Rangpur, Rajshahi and Jashore district. Rest of the healthcare
institutions follow their own or old system of disposal by burn and
burial.
Hospital Waste Management- Practices in Bangladesh

43. Hospital Waste Management in Bangladesh

45. The hospital waste management practices somehow has not been
given due attention and importance in Bangladesh. Other problems
include:
-Lack of implementation of guideline.
-Existing gaps within the Waste Management Rule 2008.
-Problem in Environmental Act 1995.
-Lack of interest and unity.
-Economic constrains.
-Inefficient management.
-Corruption.
-Hazardous waste management is not high in the political agenda.
-Inadequate enforcement of existing pollution control laws.
- Lack of supervision of final disposal of waste by responsible agency.
Challenges of Hospital Waste Management in Bangladesh

46. To remedy the situation, the MOH&FW recently sent a proposal to
the Planning Ministry on setting up of Waste Management Systems at
15 government hospitals by 2024 at a cost of around Tk 214 crore.

47. Prospects of BMW Management Industry in Future
Hospital Waste Management sector is an untapped market globally. In future, it will be a
prospective avenue both for hospitals and business entities.

49. Conclusion
hospital waste management increases safety of employees, patients
and community by reducing the potential to sustain a sharps injury,
exposure to blood-borne pathogens and reduces hospital-acquired
infections (HAIs).
Not far in time,
Hospital Waste
used to be
disposed in the
stream.